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PMF progressing toward AML (blasts in PB ≥10% accelerated, ≥20% blast-phase / post-MPN AM...

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

IDRF-PMF-BLAST-PROGRESSION
TypeRed flag
Statusreviewed 2026-04-25 | pending_clinical_signoff
DiseasesDIS-PMF
SourcesSRC-DIPSS-PLUS-GANGAT-2011 SRC-NCCN-MPN-2025

Red Flag Origin

DefinitionPMF progressing toward AML (blasts in PB ≥10% accelerated, ≥20% blast-phase / post-MPN AML), rapid splenic enlargement, or rising LDH — re-stage with BM, accelerate alloHCT, consider AML-style therapy if blast-phase
Clinical directionintensify
Categorytransformation-progression
Shifts algorithmALGO-PMF-1L

Trigger Logic

{
  "any_of": [
    {
      "comparator": ">=",
      "finding": "blasts_pb_pct",
      "threshold": 10
    },
    {
      "comparator": ">=",
      "finding": "blasts_bm_pct",
      "threshold": 10
    },
    {
      "finding": "post_mpn_aml",
      "value": true
    },
    {
      "finding": "rapid_splenomegaly_progression",
      "value": true
    },
    {
      "comparator": ">",
      "finding": "ldh_ulnratio",
      "threshold": 5
    }
  ],
  "type": "composite"
}

Notes

Post-MPN AML has dismal prognosis (~5-month median OS); ven+aza achieves modest response. Most patients with ≥10% PB blasts and fit-enough biology should be on accelerated alloHCT trajectory. STUB — requires clinical co-lead signoff.

Used By

Algorithms

Indications