Cancer survivor with prior cumulative cyclophosphamide exposure ≥7 g/m² (or ≥30 g lifetim...

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

ID	`RF-IATROGENIC-CYCLOPHOSPHAMIDE-LATE-PREVENTION`
Тип	Тривожна ознака
Статус	переглянуто 2026-05-18 \| очікує клінічного підпису
Хвороби	`DIS-UROTHELIAL`
Джерела	`SRC-COG` `SRC-NCCN-AML-2025` `SRC-NCCN-BCELL-2025` `SRC-NCCN-BLADDER-2025`

Походження тривожної ознаки

Визначення	Cancer survivor with prior cumulative cyclophosphamide exposure ≥7 g/m² (or ≥30 g lifetime in adults). Most commonly: high-dose regimens in non-Hodgkin lymphoma (Hyper-CVAD, dose-escalated CHOP variants), pediatric ALL induction-consolidation, bone-marrow transplant conditioning (Cy-TBI, Cy-Bu), autoimmune disease cycling pre-rituximab era. Two principal late-effect second-primary domains: (1) bladder cancer — acrolein metabolite causes chronic urothelial damage → urothelial carcinoma; SIR 4-7× population baseline, cumulative incidence 3-5% at 25y post-exposure, latency typically 10-20y; (2) therapy-related AML / MDS — cyclophosphamide is an alkylator; t-MDS / t-AML peak 5-10y post-exposure, cumulative ~1-3% at 10y. Cyclophosphamide also drives non-cancer late effects (premature ovarian insufficiency, hemorrhagic cystitis if no MESNA, gonadal dysfunction) — those out-of-scope for this R...
Клінічний напрям	investigate
Категорія	other

Логіка спрацьовування

{
  "any_of": [
    {
      "finding": "survivor_cyclophosphamide_cumulative_ge_7g_m2",
      "value": true
    },
    {
      "finding": "survivor_cyclophosphamide_late_effect_bladder_dimension",
      "value": true
    },
    {
      "finding": "survivor_hyper_cvad_or_high_dose_cy_history",
      "value": true
    }
  ],
  "type": "lab_value"
}

Нотатки

Cancer-survivor late-effects RedFlag for cumulative cyclophosphamide ≥7 g/m². Surveillance domains: bladder cancer (annual urinalysis + cytology, primary anchor) and t-AML/MDS (CBC q3-6mo for first 5y co-managed with RF-IATROGENIC-ALKYLATOR-TAML-PREVENTION). STUB pending two-Clinical-Co-Lead signoff per CHARTER §6.1 dev-mode.

Де використовується

Indications

IND-IATROGENIC-CYCLOPHOSPHAMIDE-LATE-PREVENTION-OBSERVATION - IND-IATROGENIC-CYCLOPHOSPHAMIDE-LATE-PREVENTION-OBSERVATION
IND-IATROGENIC-CYCLOPHOSPHAMIDE-LATE-PREVENTION-SURVEILLANCE - IND-IATROGENIC-CYCLOPHOSPHAMIDE-LATE-PREVENTION-SURVEILLANCE