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Perfil de fragilidade excluindo a indução de dose padrão VRd / D-VRd em MM: escore de fragilidades IMWG...

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IDRF-MM-FRAILTY-AGE
TipoSinal de alerta
Estadoreviewed 2026-04-25 | pending_clinical_signoff
DoençasDIS-MM
FontesSRC-ESMO-MM-2023 SRC-NCCN-MM-2025

Origem da bandeira vermelha

DefiniçãoFrailty profile precluding standard-dose VRd / D-VRd induction in MM: IMWG frailty score ≥2 (defined by age ≥80 OR age 75-79 + Charlson ≥2 OR ECOG ≥2 + albumin <3.5), OR age ≥75 with ≥1 grade-2 cardiac/pulmonary comorbidity. Impacts dose schedule (Vd-Rd weekly vs twice-weekly, reduced lenalidomide, reduced dexamethasone), not regimen choice.
Direcção clínicade escalonamento
CategoriaIdade de fragilidade
Algoritmo de deslocamentosALGO-MM-1L

Lógica de Desencadeamento

{
  "any_of": [
    {
      "comparator": ">=",
      "finding": "imwg_frailty_score",
      "threshold": 2
    },
    {
      "all_of": [
        {
          "comparator": ">=",
          "finding": "age",
          "threshold": 80
        }
      ]
    },
    {
      "all_of": [
        {
          "comparator": ">=",
          "finding": "age",
          "threshold": 75
        },
        {
          "comparator": ">=",
          "finding": "ecog",
          "threshold": 2
        },
        {
          "comparator": "<",
          "finding": "albumin_g_dl",
          "threshold": 3.5
        }
      ]
    }
  ],
  "type": "composite_score"
}

Notas

IMWG frailty score (Palumbo 2015) is validated against survival on novel-agent regimens. Frail patients on full-dose VRd have ≈15-20% treatment-related mortality vs ≈3% on dose-modified schedules. Dose-modified VRd (V weekly, R 15-25 mg, dex 20 mg weekly) preserves efficacy with substantially better tolerability. This RF de-escalates toward IND-MM-1L-VRD with dose-modified schedule (when high-risk cytogenetics + frailty co-occur — both step 1 and this trigger fire, intensify takes precedence per direction order; engine surfaces both).

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