MCL with morphologic progression to blastoid or pleomorphic variant (often with TP53 acqu...

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

ID	`RF-MCL-TRANSFORMATION-PROGRESSION`
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	MCL with morphologic progression to blastoid or pleomorphic variant (often with TP53 acquisition), OR primary-refractory disease (no CR after induction), OR early relapse <24 months post-induction (POD24-MCL analog) — high-risk subset routes to BTKi-based salvage (BTKi + rituximab + venetoclax — "VR" or BOVen) with CAR-T (brexucabtagene) consolidation when feasible.
Clinical direction	intensify
Category	transformation-progression

Trigger Logic

{
  "any_of": [
    {
      "finding": "blastoid_morphology",
      "value": true
    },
    {
      "finding": "pleomorphic_morphology",
      "value": true
    },
    {
      "finding": "mcl_primary_refractory",
      "value": true
    },
    {
      "finding": "mcl_early_relapse_lt_24mo",
      "value": true
    },
    {
      "finding": "rapid_progression",
      "value": true
    }
  ],
  "type": "composite_clinical"
}

Notes

Blastoid/pleomorphic morphology + TP53 acquisition often co-occur and predict chemoimmuno-resistance. Distinct from RF-MCL-BLASTOID-OR-TP53 (which captures these features at diagnosis as biology) — this RF triggers when morphologic conversion / refractoriness emerges during or after 1L therapy. Brexucabtagene autoleucel (ZUMA-2 — Wang NEJM 2020) ORR 87%, CR 62% in r/r MCL post-BTKi; preferred consolidation for chemo-refractory. BTKi + venetoclax + obinutuzumab (BOVen) per Le Gouill ASH 2021 highly active in TP53-mut. AlloHCT remains curative-intent option in young fit r/r MCL.

Used By

No reverse references found in the YAML corpus.