History of autologous stem-cell transplantation (ASCT) as consolidation or salvage therap...

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

ID	`RF-IATROGENIC-ASCT-SECONDARY-MDS-AML-PREVENTION`
Type	Red flag
Status	reviewed 2026-05-20 \| pending_clinical_signoff
Diseases	`DIS-AML` `DIS-MDS-HR`
Sources	`SRC-COG-LTFU-V5-2018` `SRC-EINHORN-HDCT-ASCT-2007` `SRC-NCCN-AML-2025`

Red Flag Origin

Definition	History of autologous stem-cell transplantation (ASCT) as consolidation or salvage therapy for a previously-treated hematologic or lymphoid malignancy (multiple myeloma, Hodgkin lymphoma, non- Hodgkin lymphoma, germ-cell tumor salvage, etc.). ASCT survivors carry a 10-year cumulative risk of therapy-related myelodysplastic syndrome (t-MDS) / therapy-related AML (t-AML) of approximately 1-5%, with risk dominated by the cumulative pre-ASCT alkylator dose and the conditioning-regimen-related additional alkylator exposure (high-dose melphalan in MM, BEAM in lymphoma, etc.). Median latency 3-7 years post-ASCT; risk plateaus by 10 years but does not return to baseline. Distinct from RF-IATROGENIC-ALKYLATOR-TAML-PREVENTION (general alkylator-exposure RF) by virtue of identifying the specific ASCT-survivor cohort which has documented higher absolute risk than alkylator-exposure-without-ASCT coh...
Clinical direction	investigate
Category	other

Trigger Logic

{
  "any_of": [
    {
      "finding": "prior_autologous_stem_cell_transplant_asct",
      "value": true
    },
    {
      "finding": "prior_asct_for_multiple_myeloma",
      "value": true
    },
    {
      "finding": "prior_asct_for_lymphoma",
      "value": true
    },
    {
      "finding": "prior_asct_for_germ_cell_tumor_salvage",
      "value": true
    }
  ],
  "type": "lab_value"
}

Notes

v0.3 wave-N niche pathway — ASCT-survivor t-MDS/t-AML prevention. Fires on documented history of autologous stem-cell transplantation in a prior hematologic / lymphoid malignancy (multiple myeloma, Hodgkin lymphoma, non-Hodgkin lymphoma, primary CNS lymphoma, germ- cell tumor salvage). The pre-ASCT cytotoxic exposure plus the high-dose-conditioning regimen (melphalan in MM, BEAM in lymphoma, CBV or carboplatin/etoposide/ifosfamide in salvage settings) drive bone-marrow stress and clonal-hematopoiesis emergence that predisposes to t-MDS / t-AML over the subsequent decade. Engine routes to PreventionPlan recommending: (a) IND-ASCT-SECONDARY-MDS-AML-PREVENTION-SURVEILLANCE (standard) — CBC with differential q3-6 months for the first 10 years post-ASCT, then q12mo lifelong; low-threshold marrow evaluation for any unexplained cytopenia, persistent macrocytosis (MCV >100), dysplastic peripheral smear, or unexplained monocytosis; clonal hematopoiesis-of-indeterminate- potential (CHIP) screening + risk-stratification where available; avoid additional bone-marrow-toxic exposures (additional alkylator-based therapy, benzene exposure); allogeneic HSCT eligibility pre-assessment so that if t-...

Used By

Indications

IND-ASCT-SECONDARY-MDS-AML-PREVENTION-OBSERVATION - IND-ASCT-SECONDARY-MDS-AML-PREVENTION-OBSERVATION
IND-ASCT-SECONDARY-MDS-AML-PREVENTION-SURVEILLANCE - IND-ASCT-SECONDARY-MDS-AML-PREVENTION-SURVEILLANCE