Frailty profile precluding intensive MCL induction (Nordic R-MaxiCHOP/AraC, R-DHAP) or au...

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

ID	`RF-MCL-FRAILTY-AGE`
Type	Red flag
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	`DIS-MCL`
Sources	`SRC-ESMO-MCL-2024` `SRC-NCCN-BCELL-2025`

Red Flag Origin

Definition	Frailty profile precluding intensive MCL induction (Nordic R-MaxiCHOP/AraC, R-DHAP) or autoSCT consolidation: ECOG ≥3, OR (age ≥65 with ≥2 comorbidities — autoSCT typically off-table), OR composite frailty (age ≥75 + Charlson ≥3). Triggers de-escalation to BR (StiL), R-bendamustine + cytarabine ("R-BAC500" attenuated), VR-CAP, or acalabrutinib + rituximab (chemo-free elderly path).
Clinical direction	de-escalate
Category	frailty-age

Trigger Logic

{
  "any_of": [
    {
      "comparator": ">=",
      "finding": "ecog",
      "threshold": 3
    },
    {
      "all_of": [
        {
          "comparator": ">=",
          "finding": "age",
          "threshold": 65
        },
        {
          "comparator": ">=",
          "finding": "comorbidity_grade2_count",
          "threshold": 2
        }
      ]
    },
    {
      "all_of": [
        {
          "comparator": ">=",
          "finding": "age",
          "threshold": 75
        },
        {
          "comparator": ">=",
          "finding": "charlson_score",
          "threshold": 3
        }
      ]
    },
    {
      "finding": "transplant_eligible",
      "value": false
    }
  ],
  "type": "composite_score"
}

Notes

Transplant-eligibility cutoff conventionally age <65-70 + fit; older / unfit MCL: BR (StiL NHL1 — bendamustine + R x6) is standard, with rituximab maintenance per LyMa elderly subgroup giving PFS extension. R-BAC500 (Visco regimen, R + bendamustine + lower-dose cytarabine) has high CR rates in elderly but cytopenia-heavy. SHINE trial (Wang NEJM 2022) added ibrutinib to BR maintenance in ≥65y MCL — PFS benefit but no OS, AE substantial; not yet standard. Chemo-free elderly induction with acalabrutinib + rituximab (TRIANGLE / Xian-Xiang) emerging as option for very frail.

Used By

No reverse references found in the YAML corpus.