Perfil de fragilidade excluindo imunoquímico padrão FL combinação (BR / R-CHOP / G-B / R...

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ID	`RF-FL-FRAILTY-AGE`
Tipo	Sinal de alerta
Estado	reviewed 2026-04-27 \| pending_clinical_signoff
Doenças	`DIS-FL`
Fontes	`SRC-ESMO-FL-2024` `SRC-NCCN-BCELL-2025`

Origem da bandeira vermelha

Definição	Frailty profile precluding standard FL combination immunochemo (BR / R-CHOP / G-B / R-Len): ECOG ≥3, OR (age ≥80 with any moderate comorbidity), OR composite frailty (age ≥75 + Charlson ≥3 + albumin <3.5). Triggers de-escalation to rituximab monotherapy or rituximab + chlorambucil (well-tolerated, palliative-curative balance).
Direcção clínica	de escalonamento
Categoria	Idade de fragilidade

Lógica de Desencadeamento

{
  "any_of": [
    {
      "comparator": ">=",
      "finding": "ecog",
      "threshold": 3
    },
    {
      "all_of": [
        {
          "comparator": ">=",
          "finding": "age",
          "threshold": 80
        },
        {
          "comparator": ">=",
          "finding": "comorbidity_grade2_count",
          "threshold": 1
        }
      ]
    },
    {
      "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

FL is indolent and frequently watch-and-wait appropriate. When treatment is required (per GELF criteria), rituximab monotherapy weekly x4 then maintenance — well-tolerated, response durable in low-burden disease, and can be repeated at progression. Rituximab + chlorambucil oral schedule (StiL NHL2) reasonable for mid-frailty. Avoid bendamustine in elderly with active infection / prior PJP / hypogamma — opportunistic infection risk substantial. Lenalidomide in frail elderly causes cytopenias / fatigue — start reduced-dose (10 mg) and titrate.

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