Primary myelofibrosis with DIPSS-Plus intermediate-2 or high risk — alloHCT referral mand...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-DIPSS-PLUS-HIGH`
Type	Red flag
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	`DIS-PMF`
Sources	`SRC-DIPSS-PLUS-GANGAT-2011` `SRC-ESMO-MPN-2015` `SRC-NCCN-MPN-2025`

Red Flag Origin

Definition	Primary myelofibrosis with DIPSS-Plus intermediate-2 or high risk — alloHCT referral mandatory in eligible patients (only curative option); ruxolitinib for symptom + spleen control while awaiting transplant
Clinical direction	intensify
Category	risk-score
Shifts algorithm	ALGO-PMF-1L

Trigger Logic

{
  "any_of": [
    {
      "finding": "dipss_plus_risk",
      "value": "intermediate_2"
    },
    {
      "finding": "dipss_plus_risk",
      "value": "high"
    },
    {
      "comparator": ">=",
      "finding": "dipss_plus_score",
      "threshold": 3
    }
  ],
  "type": "composite_score"
}

Notes

DIPSS-Plus (Gangat 2011) extends DIPSS with platelets <100K, RBC transfusion-dependence, unfavorable karyotype. int-2 / high → median OS ~2.9 / 1.3 years without alloHCT. AlloHCT is the only curative modality but 30-50% TRM in older patients. MIPSS70/MIPSS70+v2.0 are newer molecular extensions. Companion to RF-PMF-HIGH-RISK-DIPSS (existing, similar trigger): kept as a separately-named cross-cutting flag using the canonical risk-score nomenclature so future MDT briefs can target the named score directly.

Used By

Algorithms

ALGO-PMF-1L - ALGO-PMF-1L