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Perfil de fragilidade excluindo dose completa de DVAB ou A+AVD no linfoma clássico de Hodgkin: ECOG ≥3...

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IDRF-CHL-FRAILTY-AGE
TipoSinal de alerta
Estadoreviewed 2026-04-27 | pending_clinical_signoff
DoençasDIS-CHL
FontesSRC-ESMO-HODGKIN-2024 SRC-NCCN-BCELL-2025

Origem da bandeira vermelha

DefiniçãoFrailty profile precluding full-dose ABVD or A+AVD in classical Hodgkin lymphoma: ECOG ≥3, OR (age ≥60 with ≥2 comorbidities — elderly cHL has worse outcomes regardless of regimen), OR composite frailty (age ≥75 + Charlson ≥3 + albumin <3.5). Triggers de-escalation to AVD (omit bleomycin), VEPEMB (gem-vinorelbine-based), or BV-AVD.
Direcção clínicade escalonamento
CategoriaIdade de fragilidade

Lógica de Desencadeamento

{
  "any_of": [
    {
      "comparator": ">=",
      "finding": "ecog",
      "threshold": 3
    },
    {
      "all_of": [
        {
          "comparator": ">=",
          "finding": "age",
          "threshold": 60
        },
        {
          "comparator": ">=",
          "finding": "comorbidity_count",
          "threshold": 2
        }
      ]
    },
    {
      "all_of": [
        {
          "comparator": ">=",
          "finding": "age",
          "threshold": 75
        },
        {
          "comparator": ">=",
          "finding": "charlson_score",
          "threshold": 3
        },
        {
          "comparator": "<",
          "finding": "albumin_g_dl",
          "threshold": 3.5
        }
      ]
    }
  ],
  "type": "composite_score"
}

Notas

Elderly cHL (>60y) outcomes substantially worse — bleomycin pulmonary toxicity disproportionately high (>20% pneumonitis with BLEO in age ≥60 per German Hodgkin trials); omit bleomycin or use BV substitution (A+AVD per ECHELON-1 elderly subgroup — favorable PFS without bleo pneumonitis). Frail / unfit: VEPEMB or BV-bendamustine combinations (palliative-curative balance). BEACOPP-escalated contraindicated >60y due to TRM. CGA-guided dose adjustment essential.

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