MDS patient elderly or frail (age ≥80, ECOG ≥3, life expectancy <2 years, multiple comorb...

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

ID	`RF-MDS-FRAILTY-AGE`
Type	Red flag
Status	reviewed 2026-04-25 \| pending_clinical_signoff
Diseases	`DIS-MDS-HR` `DIS-MDS-LR`
Sources	`SRC-ESMO-MDS-2021` `SRC-NCCN-AML-2025`

Red Flag Origin

Definition	MDS patient elderly or frail (age ≥80, ECOG ≥3, life expectancy <2 years, multiple comorbidities) where best supportive care or low-intensity HMA is preferred over alloHCT or intensive disease modification
Clinical direction	de-escalate
Category	frailty-age
Shifts algorithm	ALGO-MDS-HR-1L

Trigger Logic

{
  "any_of": [
    {
      "comparator": ">=",
      "finding": "age_years",
      "threshold": 80
    },
    {
      "finding": "mds_frail_unfit",
      "value": true
    },
    {
      "all_of": [
        {
          "comparator": ">=",
          "finding": "ecog_performance_status",
          "threshold": 3
        },
        {
          "comparator": ">=",
          "finding": "comorbidities_count",
          "threshold": 3
        }
      ]
    }
  ],
  "type": "composite"
}

Notes

Triggers de-escalation: in MDS-HR, opt for HMA or best-supportive-care pathway over alloHCT (which has high TRM in this group); in MDS-LR, emphasize transfusion strategy + iron chelation + symptom management. STUB — requires clinical co-lead signoff.

Used By

Algorithms

ALGO-MDS-HR-1L - ALGO-MDS-HR-1L
ALGO-MDS-HR-2L - ALGO-MDS-HR-2L
ALGO-MDS-LR-1L - ALGO-MDS-LR-1L
ALGO-MDS-LR-2L - ALGO-MDS-LR-2L

Indications

IND-MDS-HR-1L-AZA - IND-MDS-HR-1L-AZA
IND-MDS-HR-1L-VEN-AZA - IND-MDS-HR-1L-VEN-AZA
IND-MDS-HR-ALLOHCT - IND-MDS-HR-ALLOHCT
IND-MDS-LR-2L-IMETELSTAT - IND-MDS-LR-2L-IMETELSTAT