Higher-risk MDS with IPSS-R very-high category (score >6) — alloHCT primary curative path...

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

ID	`RF-IPSS-R-VERY-HIGH`
Type	Red flag
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	`DIS-MDS-HR`
Sources	`SRC-ESMO-MDS-2021` `SRC-NCCN-AML-2025`

Red Flag Origin

Definition	Higher-risk MDS with IPSS-R very-high category (score >6) — alloHCT primary curative path in eligible; HMA (azacitidine / decitabine) bridge or non-transplant 1L; venetoclax+aza pending HR-MDS evidence maturation
Clinical direction	intensify
Category	risk-score
Shifts algorithm	ALGO-MDS-HR-1L

Trigger Logic

{
  "any_of": [
    {
      "comparator": ">",
      "finding": "ipss_r_score",
      "threshold": 6
    },
    {
      "finding": "ipss_r_risk",
      "value": "very_high"
    }
  ],
  "type": "composite_score"
}

Notes

IPSS-R (Greenberg 2012) replaced original IPSS by adding 5-tier cytogenetic risk and granular cytopenia counts. Very-high (>6) = median OS ~9 mo, AML transformation median ~0.7 yr. AlloHCT in eligible patients is curative; bridge with azacitidine 5 d / 28 d cycles per AZA-001 (Fenaux 2009). Ven+aza in HR-MDS has phase-2 evidence (VIALE-A primarily AML) — phase 3 (VERONA) reading out. Severity `critical` ensures intensification wins conflicts with generic frailty flags; alloHCT eligibility separately gates by ECOG / comorbidity (handled by RF-FITNESS-* flags).

Used By

Algorithms

ALGO-MDS-HR-1L - ALGO-MDS-HR-1L