Mantle cell lymphoma with MIPI high risk (MIPI ≥6.2 / simplified ≥6 points) — aggressive...

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

ID	`RF-MIPI-HIGH`
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	Mantle cell lymphoma with MIPI high risk (MIPI ≥6.2 / simplified ≥6 points) — aggressive disease; supports early BTK-inhibitor incorporation (TRIANGLE) and alloHCT consideration in eligible relapsed/refractory patients
Clinical direction	intensify
Category	high-risk-biology
Shifts algorithm	ALGO-MCL-1L

Trigger Logic

{
  "any_of": [
    {
      "comparator": ">=",
      "finding": "mipi_score",
      "threshold": 6.2
    },
    {
      "comparator": ">=",
      "finding": "mipi_simplified_score",
      "threshold": 6
    },
    {
      "finding": "mipi_risk_group",
      "value": "high"
    }
  ],
  "type": "composite_score"
}

Notes

MIPI high (MIPI ≥6.2 / simplified ≥6) marks the worst-prognosis MCL cohort with median OS pre-BTKi ~3-4 years. TRIANGLE (Dreyling 2024) showed adding ibrutinib to R-CHOP/R-DHAP induction + maintenance improved FFS, with comparable benefit retained when ibrutinib replaced ASCT consolidation in the experimental arm. NCCN B-cell 2025 upgrades early BTKi for high-risk MCL. AlloHCT remains the salvage pathway for relapsed-disease in fit younger MIPI-high patients. Co-fires with TP53/blastoid biomarker RFs which themselves indicate more aggressive deviation.

Used By

Algorithms

ALGO-MCL-1L - ALGO-MCL-1L