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Paciente MZL associado ao VHC frágil ou idoso: ECOG ≥3, OR idade ≥75 com comorbidades ≥2, O...

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

Origem da bandeira vermelha

DefiniçãoHCV-associated MZL patient frail or elderly: ECOG ≥3, OR age ≥75 with ≥2 comorbidities, OR composite (age ≥70 + albumin <3.0 + cirrhosis), OR explicit "unfit for combination immunochemotherapy". Most HCV-MZL patients present in the 6th-7th decade with hepatic comorbidity from long-standing HCV.
Direcção clínicade escalonamento
CategoriaIdade de fragilidade
Algoritmo de deslocamentosALGO-HCV-MZL-1L

Lógica de Desencadeamento

{
  "any_of": [
    {
      "comparator": ">=",
      "finding": "ecog",
      "threshold": 3
    },
    {
      "finding": "fit_for_combination_chemo",
      "value": false
    },
    {
      "all_of": [
        {
          "comparator": ">=",
          "finding": "age",
          "threshold": 75
        },
        {
          "comparator": ">=",
          "finding": "comorbidity_count",
          "threshold": 2
        }
      ]
    },
    {
      "all_of": [
        {
          "comparator": ">=",
          "finding": "age",
          "threshold": 70
        },
        {
          "comparator": "<",
          "finding": "albumin_g_dl",
          "threshold": 3.0
        },
        {
          "finding": "cirrhosis_present",
          "value": true
        }
      ]
    }
  ],
  "type": "composite_score"
}

Notas

HCV-MZL is typically indolent and DAA-responsive — antiviral therapy alone (DAA: glecaprevir/pibrentasvir or sofosbuvir/velpatasvir) produces ~75% lymphoma response when achieved viral cure (Arcaini 2014). Frail patients should preferentially receive DAA-only with watch-and-wait for the lymphoma; reserve immunochemotherapy (R-bendamustine, R-CVP) for symptomatic / progressive disease after SVR. Bendamustine in elderly: high infection risk, monitor lymphocyte recovery + add PJP prophylaxis. Cirrhotic + frail: prefer rituximab- monotherapy. Geriatric assessment recommended.

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