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Long-term thiopurine exposure ≥3-5 years — azathioprine or its active metabolite 6-mercap...

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

IDRF-IATROGENIC-AZATHIOPRINE-LONGTERM-PREVENTION
ТипТривожна ознака
Статуспереглянуто 2026-05-18 | очікує клінічного підпису
ХворобиDIS-BCC DIS-DLBCL-NOS
ДжерелаSRC-IARC-MONO-100B-2012 SRC-NCCN-BCELL-2025 SRC-NCCN-SKIN-2025

Походження тривожної ознаки

ВизначенняLong-term thiopurine exposure ≥3-5 years — azathioprine or its active metabolite 6-mercaptopurine (6-MP) — across inflammatory bowel disease (Crohn disease, ulcerative colitis), rheumatoid arthritis, systemic lupus erythematosus, autoimmune hepatitis, transplant maintenance, and other autoimmune indications. IARC Group 1 carcinogen (azathioprine). Mechanism: thio-purine metabolites incorporate into DNA → impaired mismatch-repair + photo-sensitization (UV-A absorption by 6-thioguanine in DNA generates reactive oxygen species). Risk profile: lymphoma 4-6x population risk (predominantly diffuse large B-cell lymphoma; in some IBD cohorts hepatosplenic T-cell lymphoma appears with anti-TNF combination — see separate anti-TNF RF); non-melanoma skin cancer (especially SCC) 4-10x background, magnitude scaling with cumulative dose-years and UV exposure; modest melanoma signal; in IBD specificall...
Клінічний напрямinvestigate
Категоріяother

Логіка спрацьовування

{
  "any_of": [
    {
      "finding": "azathioprine_continuous_use_ge_3y",
      "value": true
    },
    {
      "finding": "mercaptopurine_continuous_use_ge_3y",
      "value": true
    },
    {
      "finding": "thiopurine_cumulative_use_ge_3y",
      "value": true
    }
  ],
  "type": "lab_value"
}

Нотатки

Prevention-persona RedFlag for long-term ≥3y thiopurine (azathioprine / 6-MP) exposure. Engine routes to PreventionPlan recommending (1) annual whole-body skin exam by dermatologist + aggressive sun-protection counseling, (2) EBV serology baseline check in young adults pre-initiation (avoid initiation in EBV-seronegative young men per ECCO 2019), (3) annual B-symptom + lymphadenopathy review, (4) shared-decision discussion of indication continuation vs alternatives (MTX for RA, biologics for IBD) at year 5, (5) HPV vaccination catch-up where applicable. Anchored to DIS-DLBCL-NOS (lymphoma) + DIS-BCC (closest skin-cancer anchor for SCC and BCC). STUB pending two-Clinical-Co-Lead signoff per CHARTER §6.1 dev-mode.

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Indications