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History of cumulative anthracycline exposure ≥250 mg/m² (doxorubicin equivalent) — typica...

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

IDRF-IATROGENIC-ANTHRACYCLINE-CARDIO-PREVENTION
TypeRed flag
Statusreviewed 2026-05-18 | pending_clinical_signoff
DiseasesDIS-AML
SourcesSRC-NCCN-AML-2025 SRC-NCCN-BCELL-2025 SRC-NCCN-BREAST-2025

Red Flag Origin

DefinitionHistory of cumulative anthracycline exposure ≥250 mg/m² (doxorubicin equivalent) — typically reached in breast cancer adjuvant AC/EC regimens, lymphoma CHOP/R-CHOP cohorts ≥6 cycles, pediatric ALL/AML induction, sarcoma + germ-cell regimens. Anthracyclines cause dose- dependent cardiotoxicity: irreversible cardiomyocyte loss → cardiomyopathy → heart failure (HF). Lifetime HF incidence rises with cumulative dose: ~5% at 400 mg/m², ~26% at 550 mg/m², ~48% at 700 mg/m² (legacy ANT- exposure cohorts). Modern cardioprotection (dexrazoxane, liposomal doxorubicin, infusion schedule, baseline + serial echo + BNP/troponin) modulate but do not eliminate risk. Concurrent trastuzumab amplifies risk. Anthracyclines are also topoisomerase-II inhibitors — patient ALSO fires RF-IATROGENIC-TOPO2-TAML-PREVENTION for t-AML surveillance. This RF specifically covers cardiac surveillance. Prevention-persona...
Clinical directioninvestigate
Categoryother

Trigger Logic

{
  "any_of": [
    {
      "finding": "anthracycline_cumulative_dose_ge_250_mg_m2",
      "value": true
    },
    {
      "finding": "anthracycline_with_trastuzumab_exposure",
      "value": true
    },
    {
      "finding": "anthracycline_with_chest_radiation_exposure",
      "value": true
    },
    {
      "finding": "pediatric_anthracycline_exposure",
      "value": true
    }
  ],
  "type": "lab_value"
}

Notes

Prevention-persona RedFlag for anthracycline cumulative dose ≥250 mg/m². Cardio surveillance focus (HF / cardiomyopathy); t-AML surveillance overlap covered by separate RF-IATROGENIC-TOPO2-TAML-PREVENTION. Echo q1-5y depending on risk profile (ASCO/COG-LTFU cadence). Engine routes to PreventionPlan recommending baseline + serial echo + BNP. STUB pending two-Clinical-Co-Lead signoff per CHARTER §6.1 dev-mode.

Used By

Indications

Red flag