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Active or latent infection requiring resolution / prophylaxis before initiating MM induct...

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

IDRF-MM-INFECTION-SCREENING
TypeRed flag
Statusreviewed 2026-04-25 | pending_clinical_signoff
DiseasesDIS-MM
SourcesSRC-ESMO-MM-2023 SRC-NCCN-MM-2025

Red Flag Origin

DefinitionActive or latent infection requiring resolution / prophylaxis before initiating MM induction (VRd, D-VRd): HBsAg+ or anti-HBc+ (HBV reactivation risk on dexamethasone + anti-CD38 in D-VRd; reactivation rate ≈8-15% on daratumumab without prophylaxis), HIV+, or active TB.
Clinical directionhold
Categoryinfection-screening

Trigger Logic

{
  "any_of": [
    {
      "finding": "hbsag",
      "value": "positive"
    },
    {
      "finding": "anti_hbc_total",
      "value": "positive"
    },
    {
      "finding": "hiv_status",
      "value": "positive"
    },
    {
      "finding": "active_tb",
      "value": true
    }
  ],
  "type": "lab_value"
}

Notes

Daratumumab + dexamethasone amplifies HBV reactivation risk vs bortezomib-only regimens — entecavir or tenofovir prophylaxis from cycle-1 day-1 through 12 months post-last-dara. HIV+ MM uses HIV-aware regimen choice (no R, no rituximab — same VRd works on ART); baseline CD4 documentation required. Active TB: complete intensive phase before steroids + anti-CD38.

Used By

Algorithms

Indications