Composite eligibility for autologous stem-cell transplantation (ASCT) consolidation: ECOG...

Детермінований перегляд YAML-сутності з джерельної бази. Клінічний авторитет лишається за вказаними source ID та статусом клінічного sign-off.

ID	`RF-ASCT-ELIGIBLE-COMPOSITE`
Тип	Тривожна ознака
Статус	переглянуто 2026-04-27 \| очікує клінічного підпису
Хвороби	Не вказано
Джерела	`SRC-EHA-EMN-MM-2025` `SRC-NCCN-BCELL-2025` `SRC-NCCN-MM-2025`

Походження тривожної ознаки

Визначення	Composite eligibility for autologous stem-cell transplantation (ASCT) consolidation: ECOG ≤2 AND adequate cardiac function (LVEF ≥50%, no NYHA III-IV) AND adequate pulmonary function (DLCO ≥50% or absent severe COPD/fibrosis) AND adequate hepatic function (bilirubin ≤2× ULN, AST/ALT ≤3× ULN) AND adequate renal function (CrCl ≥30 mL/min) AND age <70 (lymphoma/MM standard) or <65 (AML standard) AND no active uncontrolled infection AND no second active malignancy. Used to gate ASCT consolidation in MM 1L (CASSIOPEIA, GRIFFIN), DLBCL/PTCL salvage (CORAL, ECHELON-2 follow-up), Hodgkin salvage (post-second-line PR/CR), AML CR1 in non-favorable risk if alloHCT donor unavailable.
Клінічний напрям	intensify
Категорія	other

Логіка спрацьовування

{
  "all_of": [
    {
      "comparator": "<=",
      "finding": "ecog",
      "threshold": 2
    },
    {
      "comparator": ">=",
      "finding": "lvef_percent",
      "threshold": 50
    },
    {
      "comparator": ">=",
      "finding": "creatinine_clearance_ml_min",
      "threshold": 30
    },
    {
      "comparator": "<=",
      "finding": "bilirubin_ratio_to_uln",
      "threshold": 2
    },
    {
      "finding": "active_uncontrolled_infection",
      "value": false
    },
    {
      "any_of": [
        {
          "comparator": "<",
          "finding": "age_years",
          "threshold": 70
        },
        {
          "finding": "asct_age_eligible",
          "value": true
        }
      ]
    }
  ],
  "type": "composite_score"
}

Нотатки

Composite gate harmonized across landmark ASCT trials. AML uses age <65 cutoff (more restrictive than lymphoma/MM <70) due to higher TRM in older AML alloHCT/ASCT pathways; chronological age is a proxy — biologic-age assessment (CGA, HCT-CI score) overrides for borderline cases. DLCO threshold 50% is a hard limit for many centers; 40-50% with cardiopulmonary fitness clearance acceptable on individual basis. Frailty score (Palumbo IMWG-frailty for MM, G8 for solid/lymphoma) preferred over isolated age cutoff. RF coexists with RF-CAR-T-ELIGIBLE for cases where both are options (DLBCL 2L: ZUMA-7/TRANSFORM established CAR-T over ASCT in early relapse <12 mo or primary refractory; ASCT remains standard for late-relapse R/R DLBCL post-CR). MM tandem-ASCT (StaMINA) for high-risk cytogenetics — additional gate when this RF fires AND RF-MM-HIGH-RISK-CYTOGENETICS fires.

Де використовується

Algorithms

ALGO-DLBCL-2L - ALGO-DLBCL-2L