History of prior cumulative alkylating-agent chemotherapy exposure (cyclophosphamide, ifo...

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

ID	`RF-IATROGENIC-ALKYLATOR-TAML-PREVENTION`
Type	Red flag
Status	reviewed 2026-05-18 \| pending_clinical_signoff
Diseases	`DIS-AML`
Sources	`SRC-NCCN-AML-2025` `SRC-NCCN-BCELL-2025`

Red Flag Origin

Definition	History of prior cumulative alkylating-agent chemotherapy exposure (cyclophosphamide, ifosfamide, melphalan, busulfan, chlorambucil, procarbazine, bendamustine, BCNU/CCNU/lomustine, dacarbazine, temozolomide) ≥5 years prior. Therapy-related AML (t-AML) and therapy-related MDS following alkylator exposure has characteristic features: median latency 5-7 years post-exposure (longer than topoisomerase-II-inhibitor t-AML), preceded often by t-MDS phase with chromosomes 5q-/-5 or 7q-/-7 cytogenetics, complex karyotype. Cumulative incidence ~1-10% at 10y depending on dose + concurrent RT + age. Highest risk: Hodgkin lymphoma survivors (MOPP-era), multiple myeloma (melphalan), pediatric sarcoma survivors. Prevention-persona RedFlag (§20 v0.3 iatrogenic pilot).
Clinical direction	investigate
Category	other

Trigger Logic

{
  "any_of": [
    {
      "finding": "prior_alkylator_chemo_ge_5y_ago",
      "value": true
    },
    {
      "finding": "prior_high_cumulative_alkylator_dose",
      "value": true
    },
    {
      "finding": "prior_hodgkin_lymphoma_alkylator_regimen",
      "value": true
    },
    {
      "finding": "prior_melphalan_multiple_myeloma_therapy",
      "value": true
    }
  ],
  "type": "lab_value"
}

Notes

Prevention-persona RedFlag for prior alkylator chemotherapy exposure. Median t-AML latency 5-7y post-exposure; cumulative incidence ~1-10% at 10y. Engine routes to PreventionPlan recommending CBC q3-6mo for first 10y post-chemo + low threshold for marrow evaluation if cytopenias appear. STUB pending two-Clinical-Co-Lead signoff per CHARTER §6.1 dev-mode.

Used By

Indications

IND-IATROGENIC-ALKYLATOR-TAML-PREVENTION-OBSERVATION - IND-IATROGENIC-ALKYLATOR-TAML-PREVENTION-OBSERVATION
IND-IATROGENIC-ALKYLATOR-TAML-PREVENTION-SURVEILLANCE - IND-IATROGENIC-ALKYLATOR-TAML-PREVENTION-SURVEILLANCE
IND-IATROGENIC-CYCLOPHOSPHAMIDE-LATE-PREVENTION-SURVEILLANCE - IND-IATROGENIC-CYCLOPHOSPHAMIDE-LATE-PREVENTION-SURVEILLANCE
IND-IATROGENIC-PLATINUM-LATE-PREVENTION-SURVEILLANCE - IND-IATROGENIC-PLATINUM-LATE-PREVENTION-SURVEILLANCE

Red flag

RF-IATROGENIC-CYCLOPHOSPHAMIDE-LATE-PREVENTION - Cancer survivor with prior cumulative cyclophosphamide exposure ≥7 g/m² (or ≥30 g lifetim...