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MDS progressing to AML (≥20% blasts) or accelerated MDS-IB2 with rapid progression on HMA...

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

IDRF-MDS-TRANSFORMATION-PROGRESSION
TypeRed flag
Statusreviewed 2026-04-25 | pending_clinical_signoff
DiseasesDIS-MDS-HR DIS-MDS-LR
SourcesSRC-ESMO-MDS-2021 SRC-NCCN-AML-2025

Red Flag Origin

DefinitionMDS progressing to AML (≥20% blasts) or accelerated MDS-IB2 with rapid progression on HMA — switch to AML algorithm or escalate to ven+aza / intensive chemo + alloHCT bridge
Clinical directionintensify
Categorytransformation-progression
Shifts algorithmALGO-MDS-HR-1L, ALGO-MDS-LR-1L

Trigger Logic

{
  "any_of": [
    {
      "comparator": ">=",
      "finding": "bm_blasts_pct",
      "threshold": 20
    },
    {
      "finding": "hma_failure",
      "value": true
    },
    {
      "finding": "rapid_blast_increase",
      "value": true
    },
    {
      "finding": "mds_to_aml_transformation",
      "value": true
    }
  ],
  "type": "composite"
}

Notes

≥20% blasts = AML by WHO 2022; switch to AML algorithm. HMA failure in MDS-HR has dismal prognosis (~6-month median OS without alloHCT); ven+aza or intensive chemo + alloHCT bridge are the rescue options. STUB — requires clinical co-lead signoff.

Used By

Algorithms

Indications