Onco Wiki / Red flag

Multiple myeloma with R-ISS stage 3 — ISS-3 (β2M ≥5.5) PLUS LDH above ULN PLUS high-risk...

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

Red Flag Origin

Trigger Logic

{
  "all_of": [
    {
      "comparator": ">=",
      "finding": "beta2_microglobulin_mg_per_l",
      "threshold": 5.5
    },
    {
      "finding": "ldh_above_uln",
      "value": true
    },
    {
      "any_of": [
        {
          "finding": "mm_high_risk_cytogenetics",
          "value": true
        },
        {
          "finding": "fish_t_4_14",
          "value": true
        },
        {
          "finding": "fish_t_14_16",
          "value": true
        },
        {
          "finding": "fish_del_17p",
          "value": true
        },
        {
          "finding": "tp53_deletion",
          "value": true
        }
      ]
    }
  ],
  "type": "composite_score"
}

Notes

R-ISS (Palumbo et al., JCO 2015) refined ISS by adding LDH and FISH cytogenetics: R-ISS-3 = ISS-3 + LDH-high + high-risk FISH. R-ISS-3 median OS ~43 mo pre-daratumumab; modern PERSEUS / IsKia / GRIFFIN show D-VRd benefits across risk groups but absolute outcomes in R-ISS-3 remain inferior — argues for tandem ASCT consideration (StaMINA / EMN02) and aggressive maintenance (lenalidomide +/- daratumumab + ixazomib in selected protocols). Severity `critical` for conflict resolution: this should win over standard de-escalation flags. Co-fires with biomarker-actionability flags for individual cytogenetic hits.

Used By

Algorithms

• ALGO-MM-1L - ALGO-MM-1L

Red flag

• RF-ISS-3 - Multiple myeloma with ISS stage 3 — β2-microglobulin ≥5.5 mg/L — high-risk presentation;...