Mantle cell lymphoma with MIPI low risk (MIPI <5.7 / 0-3 simplified points) — supports st...

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

ID	`RF-MIPI-LOW`
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 low risk (MIPI <5.7 / 0-3 simplified points) — supports standard intensified induction in fit younger patients (Nordic / R-DHAP-based) without further treatment escalation
Clinical direction	de-escalate
Category	high-risk-biology
Shifts algorithm	ALGO-MCL-1L

Trigger Logic

{
  "any_of": [
    {
      "comparator": "<",
      "finding": "mipi_score",
      "threshold": 5.7
    },
    {
      "comparator": "<=",
      "finding": "mipi_simplified_score",
      "threshold": 3
    },
    {
      "finding": "mipi_risk_group",
      "value": "low"
    }
  ],
  "type": "composite_score"
}

Notes

MIPI (Hoster 2008) is the validated MCL prognostic index combining age, ECOG, LDH, WBC. MIPI low-risk has 5-yr OS ~80%; intermediate ~60%; high ~35%. In fit younger MCL, low-risk MIPI without TP53 / blastoid features supports the standard ASCT-eligible Nordic / alternating R-CHOP/R-DHAP backbone — no need to add early BTKi (TRIANGLE outcome favored ibrutinib in all-comers but Ukraine access constraints make low-risk patients pragmatic candidates for the classic intensified arm). de-escalate direction means "do not add further intensification beyond the fit-younger Nordic baseline".

Used By

Algorithms

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