PMF intermediate-2 or high risk by DIPSS-Plus — alloHCT referral mandatory in eligible pa...

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

ID	`RF-PMF-HIGH-RISK-DIPSS`
Type	Red flag
Status	reviewed 2026-04-25 \| pending_clinical_signoff
Diseases	`DIS-PMF`
Sources	`SRC-DIPSS-PLUS-GANGAT-2011` `SRC-ESMO-MPN-2015` `SRC-NCCN-MPN-2025`

Red Flag Origin

Definition	PMF intermediate-2 or high risk by DIPSS-Plus — alloHCT referral mandatory in eligible patients (only curative option); ruxolitinib for symptomatic splenomegaly + symptoms while awaiting transplant
Clinical direction	intensify
Category	high-risk-biology
Shifts algorithm	ALGO-PMF-1L

Trigger Logic

{
  "any_of": [
    {
      "finding": "dipss_plus_risk",
      "value": "intermediate_2"
    },
    {
      "finding": "dipss_plus_risk",
      "value": "high"
    },
    {
      "finding": "mipss70_risk",
      "value": "high"
    },
    {
      "finding": "mipss70_risk",
      "value": "very_high"
    }
  ],
  "type": "risk_score"
}

Notes

DIPSS-Plus int-2 / high → median OS ~2.9 / 1.3 years without alloHCT. AlloHCT in fit patients improves OS but carries 30-50% TRM. Ruxolitinib bridges symptoms + spleen; does NOT eliminate clone but may extend OS in pooled COMFORT analyses. STUB — requires clinical co-lead signoff.

Used By

Algorithms

ALGO-PMF-1L - ALGO-PMF-1L
ALGO-PMF-2L - ALGO-PMF-2L

Indications

IND-PMF-1L-OBSERVATION - IND-PMF-1L-OBSERVATION
IND-PMF-1L-RUXOLITINIB - IND-PMF-1L-RUXOLITINIB
IND-PMF-2L-FEDRATINIB - IND-PMF-2L-FEDRATINIB
IND-PMF-ALLOHCT-HIGH-RISK - IND-PMF-ALLOHCT-HIGH-RISK
IND-PMF-MOMELOTINIB-ANEMIA - IND-PMF-MOMELOTINIB-ANEMIA

Red flag

RF-DIPSS-PLUS-HIGH - Primary myelofibrosis with DIPSS-Plus intermediate-2 or high risk — alloHCT referral mand...