name: 'mpn-progression-monitor-agent'
description: 'AI-powered myeloproliferative neoplasm monitoring for disease progression prediction, treatment response tracking, and transformation risk assessment in PV, ET, and myelofibrosis.'
measurable_outcome: Execute skill workflow successfully with valid output within 15 minutes.
allowed-tools:
- read_file
- run_shell_command
MPN Progression Monitor Agent
The MPN Progression Monitor Agent provides comprehensive monitoring of myeloproliferative neoplasms (PV, ET, MF) for disease progression, treatment response, and transformation risk. It integrates molecular profiling, clinical parameters, and AI-based risk models to guide management of chronic phase disease and predict blast transformation.
When to Use This Skill
- When monitoring JAK2/CALR/MPL mutation burden over time.
- For predicting fibrosis progression in PV/ET.
- To assess risk of blast transformation.
- When tracking treatment response to JAK inhibitors.
- For calculating dynamic risk scores (DIPSS, MIPSS70).
Core Capabilities
Mutation Monitoring: Track driver and high-risk mutation VAF.
Progression Prediction: Model fibrosis and transformation risk.
Risk Scoring: Calculate DIPSS, MIPSS70+, MTSS dynamically.
Treatment Response: Assess molecular and clinical response.
Clone Evolution: Track clonal dynamics and new mutations.
Transplant Timing: Optimize allo-HSCT timing decisions.
MPN Classification
| MPN Type |
Driver Mutations |
Progression Risk |
| PV |
JAK2 V617F (95%), JAK2 exon 12 |
Fibrosis 10-15%, AML 2-5% |
| ET |
JAK2 (55%), CALR (25%), MPL (5%) |
Fibrosis 5-10%, AML 1-2% |
| Pre-PMF |
Same as PMF |
Variable |
| PMF |
JAK2 (60%), CALR (25%), MPL (5%) |
AML 10-20% |
High-Risk Mutations
| Mutation |
Impact |
MF Association |
| ASXL1 |
Adverse |
Strong |
| SRSF2 |
Adverse |
Strong (PMF) |
| EZH2 |
Adverse |
Moderate |
| IDH1/2 |
Adverse |
Transformation |
| RUNX1 |
Very Adverse |
Transformation |
| TP53 |
Very Adverse |
Transformation |
| U2AF1 |
Adverse |
Moderate |
Risk Scores
| Score |
Components |
Application |
| IPSS |
Age, Hb, WBC, blasts, symptoms |
PMF at diagnosis |
| DIPSS |
Same, dynamic |
PMF follow-up |
| DIPSS+ |
+ karyotype, transfusion, platelets |
PMF refined |
| MIPSS70 |
Molecular markers |
Transplant-age PMF |
| MIPSS70+ v2.0 |
+ U2AF1, karyotype |
Most comprehensive |
| MTSS |
Transplant-specific |
Allo-HSCT outcomes |
Workflow
Input: Serial molecular testing, CBC, clinical parameters.
Baseline Assessment: Calculate initial risk score.
Mutation Tracking: Monitor VAF trends over time.
Risk Recalculation: Update scores at each timepoint.
Progression Detection: Identify molecular/clinical progression.
Treatment Assessment: Evaluate response to therapy.
Output: Dynamic risk assessment, progression alerts, recommendations.
Example Usage
User: "Monitor this myelofibrosis patient's disease trajectory and update risk scores with new molecular data."
Agent Action:
python3 Skills/Hematology/MPN_Progression_Monitor_Agent/mpn_monitor.py \
--patient_id MF_001 \
--molecular_data serial_mutations.csv \
--cbc_data serial_cbc.csv \
--clinical_data symptoms.json \
--mpn_type pmf \
--baseline_date 2024-01-15 \
--calculate_scores dipss,mipss70 \
--output mpn_monitoring/
Input Requirements
| Data Type |
Parameters |
Frequency |
| Molecular |
JAK2/CALR/MPL VAF, NGS panel |
q3-6 months |
| CBC |
Hb, WBC, platelets, blasts |
Monthly |
| Clinical |
Symptoms, spleen size |
q3 months |
| Bone Marrow |
Fibrosis grade, cytogenetics |
q6-12 months |
Output Components
| Output |
Description |
Format |
| Risk Scores |
DIPSS, MIPSS70 over time |
.csv |
| VAF Trends |
Mutation burden plots |
.png |
| Progression Alert |
Warning if criteria met |
.json |
| Response Assessment |
IWG-MRT criteria |
.json |
| Transplant Timing |
Recommendation if indicated |
.json |
| Clone Evolution |
New mutations, clonal shifts |
.csv |
Progression Criteria
| Progression Type |
Criteria |
Action |
| Clinical |
New symptoms, splenomegaly |
Intensify therapy |
| Hematologic |
Cytopenias, increased blasts |
BMB, cytogenetics |
| Molecular |
New high-risk mutations |
Risk restaging |
| Fibrotic |
Increased fibrosis grade |
Consider transplant |
| Blast Phase |
≥20% blasts |
Urgent intervention |
Response Criteria (IWG-MRT)
| Response |
Definition |
Implications |
| Complete Remission |
No disease manifestations |
Excellent outcome |
| Partial Remission |
>50% improvement |
Good response |
| Clinical Improvement |
Symptom/spleen improvement |
Benefit |
| Stable Disease |
No change |
Observe |
| Progressive Disease |
Progression criteria |
Change therapy |
AI/ML Components
Progression Prediction:
- Survival analysis with molecular features
- Random survival forests
- Deep learning time-to-event
Clone Tracking:
- VAF trajectory modeling
- New clone detection
- Evolutionary tree inference
Transplant Decision:
- Survival benefit modeling
- NRM prediction
- Optimal timing algorithms
Treatment Response Monitoring
| Therapy |
Response Markers |
Timeline |
| Ruxolitinib |
Spleen, symptoms, JAK2 VAF |
12-24 weeks |
| Fedratinib |
Similar to ruxolitinib |
24 weeks |
| Momelotinib |
+ anemia improvement |
24 weeks |
| Interferon |
Molecular response, JAK2 VAF |
12+ months |
Prerequisites
- Python 3.10+
- lifelines, scikit-survival
- Variant annotation tools
- Risk score calculators
- Visualization libraries
Related Skills
- CHIP_Clonal_Hematopoiesis_Agent - Pre-MPN states
- MDS_Classification_Agent - Overlap syndromes
- Bone_Marrow_AI_Agent - Morphology analysis
- Coagulation_Thrombosis_Agent - Thrombosis risk
Thrombosis Risk in MPN
| Factor |
Risk Increase |
Management |
| Age >60 |
2-3x |
Cytoreduction |
| Prior thrombosis |
3-5x |
Anticoagulation |
| JAK2 V617F |
2x |
Higher for homozygous |
| High WBC |
1.5-2x |
Control counts |
| CV risk factors |
Additive |
Aggressive management |
Special Considerations
- Triple-Negative MPN: Different prognosis, consider other diagnoses
- Cytogenetic Evolution: High-risk signal, BMB follow-up
- New Mutations: May indicate disease evolution
- Treatment Resistance: Consider second-line or transplant
- Quality of Life: Balance treatment intensity
Transplant Indications
| Indication |
Criteria |
Timing |
| High-Risk PMF |
MIPSS70+ high/very high |
Consider early |
| Blast Phase |
≥20% blasts |
Urgent if fit |
| Refractory Disease |
Failed JAKi |
Evaluate |
| Transfusion Dependence |
RBC/platelet dependent |
Factor in decision |
Author
AI Group - Biomedical AI Platform
1---2name: mpn-progression-monitor-agent3description: <!--4---5<!--6# COPYRIGHT NOTICE7# This file is part of the "Universal Biomedical Skills" project.8# Copyright (c) 2026 MD BABU MIA, PhD <md.babu.mia@mssm.edu>9# All Rights Reserved.10#11# This code is proprietary and confidential.12# Unauthorized copying of this file, via any medium is strictly prohibited.13#14# Provenance: Authenticated by MD BABU MIA1516-->1718---19name: 'mpn-progression-monitor-agent'20description: 'AI-powered myeloproliferative neoplasm monitoring for disease progression prediction, treatment response tracking, and transformation risk assessment in PV, ET, and myelofibrosis.'21measurable_outcome: Execute skill workflow successfully with valid output within 15 minutes.22allowed-tools:23 - read_file24 - run_shell_command25---262728# MPN Progression Monitor Agent2930The **MPN Progression Monitor Agent** provides comprehensive monitoring of myeloproliferative neoplasms (PV, ET, MF) for disease progression, treatment response, and transformation risk. It integrates molecular profiling, clinical parameters, and AI-based risk models to guide management of chronic phase disease and predict blast transformation.3132## When to Use This Skill3334* When monitoring JAK2/CALR/MPL mutation burden over time.35* For predicting fibrosis progression in PV/ET.36* To assess risk of blast transformation.37* When tracking treatment response to JAK inhibitors.38* For calculating dynamic risk scores (DIPSS, MIPSS70).3940## Core Capabilities41421. **Mutation Monitoring**: Track driver and high-risk mutation VAF.43442. **Progression Prediction**: Model fibrosis and transformation risk.45463. **Risk Scoring**: Calculate DIPSS, MIPSS70+, MTSS dynamically.47484. **Treatment Response**: Assess molecular and clinical response.49505. **Clone Evolution**: Track clonal dynamics and new mutations.51526. **Transplant Timing**: Optimize allo-HSCT timing decisions.5354## MPN Classification5556| MPN Type | Driver Mutations | Progression Risk |57|----------|------------------|------------------|58| PV | JAK2 V617F (95%), JAK2 exon 12 | Fibrosis 10-15%, AML 2-5% |59| ET | JAK2 (55%), CALR (25%), MPL (5%) | Fibrosis 5-10%, AML 1-2% |60| Pre-PMF | Same as PMF | Variable |61| PMF | JAK2 (60%), CALR (25%), MPL (5%) | AML 10-20% |6263## High-Risk Mutations6465| Mutation | Impact | MF Association |66|----------|--------|----------------|67| ASXL1 | Adverse | Strong |68| SRSF2 | Adverse | Strong (PMF) |69| EZH2 | Adverse | Moderate |70| IDH1/2 | Adverse | Transformation |71| RUNX1 | Very Adverse | Transformation |72| TP53 | Very Adverse | Transformation |73| U2AF1 | Adverse | Moderate |7475## Risk Scores7677| Score | Components | Application |78|-------|------------|-------------|79| IPSS | Age, Hb, WBC, blasts, symptoms | PMF at diagnosis |80| DIPSS | Same, dynamic | PMF follow-up |81| DIPSS+ | + karyotype, transfusion, platelets | PMF refined |82| MIPSS70 | Molecular markers | Transplant-age PMF |83| MIPSS70+ v2.0 | + U2AF1, karyotype | Most comprehensive |84| MTSS | Transplant-specific | Allo-HSCT outcomes |8586## Workflow87881. **Input**: Serial molecular testing, CBC, clinical parameters.89902. **Baseline Assessment**: Calculate initial risk score.91923. **Mutation Tracking**: Monitor VAF trends over time.93944. **Risk Recalculation**: Update scores at each timepoint.95965. **Progression Detection**: Identify molecular/clinical progression.97986. **Treatment Assessment**: Evaluate response to therapy.991007. **Output**: Dynamic risk assessment, progression alerts, recommendations.101102## Example Usage103104**User**: "Monitor this myelofibrosis patient's disease trajectory and update risk scores with new molecular data."105106**Agent Action**:107```bash108python3 Skills/Hematology/MPN_Progression_Monitor_Agent/mpn_monitor.py \109 --patient_id MF_001 \110 --molecular_data serial_mutations.csv \111 --cbc_data serial_cbc.csv \112 --clinical_data symptoms.json \113 --mpn_type pmf \114 --baseline_date 2024-01-15 \115 --calculate_scores dipss,mipss70 \116 --output mpn_monitoring/117```118119## Input Requirements120121| Data Type | Parameters | Frequency |122|-----------|------------|-----------|123| Molecular | JAK2/CALR/MPL VAF, NGS panel | q3-6 months |124| CBC | Hb, WBC, platelets, blasts | Monthly |125| Clinical | Symptoms, spleen size | q3 months |126| Bone Marrow | Fibrosis grade, cytogenetics | q6-12 months |127128## Output Components129130| Output | Description | Format |131|--------|-------------|--------|132| Risk Scores | DIPSS, MIPSS70 over time | .csv |133| VAF Trends | Mutation burden plots | .png |134| Progression Alert | Warning if criteria met | .json |135| Response Assessment | IWG-MRT criteria | .json |136| Transplant Timing | Recommendation if indicated | .json |137| Clone Evolution | New mutations, clonal shifts | .csv |138139## Progression Criteria140141| Progression Type | Criteria | Action |142|------------------|----------|--------|143| Clinical | New symptoms, splenomegaly | Intensify therapy |144| Hematologic | Cytopenias, increased blasts | BMB, cytogenetics |145| Molecular | New high-risk mutations | Risk restaging |146| Fibrotic | Increased fibrosis grade | Consider transplant |147| Blast Phase | ≥20% blasts | Urgent intervention |148149## Response Criteria (IWG-MRT)150151| Response | Definition | Implications |152|----------|------------|--------------|153| Complete Remission | No disease manifestations | Excellent outcome |154| Partial Remission | >50% improvement | Good response |155| Clinical Improvement | Symptom/spleen improvement | Benefit |156| Stable Disease | No change | Observe |157| Progressive Disease | Progression criteria | Change therapy |158159## AI/ML Components160161**Progression Prediction**:162- Survival analysis with molecular features163- Random survival forests164- Deep learning time-to-event165166**Clone Tracking**:167- VAF trajectory modeling168- New clone detection169- Evolutionary tree inference170171**Transplant Decision**:172- Survival benefit modeling173- NRM prediction174- Optimal timing algorithms175176## Treatment Response Monitoring177178| Therapy | Response Markers | Timeline |179|---------|------------------|----------|180| Ruxolitinib | Spleen, symptoms, JAK2 VAF | 12-24 weeks |181| Fedratinib | Similar to ruxolitinib | 24 weeks |182| Momelotinib | + anemia improvement | 24 weeks |183| Interferon | Molecular response, JAK2 VAF | 12+ months |184185## Prerequisites186187* Python 3.10+188* lifelines, scikit-survival189* Variant annotation tools190* Risk score calculators191* Visualization libraries192193## Related Skills194195* CHIP_Clonal_Hematopoiesis_Agent - Pre-MPN states196* MDS_Classification_Agent - Overlap syndromes197* Bone_Marrow_AI_Agent - Morphology analysis198* Coagulation_Thrombosis_Agent - Thrombosis risk199200## Thrombosis Risk in MPN201202| Factor | Risk Increase | Management |203|--------|---------------|------------|204| Age >60 | 2-3x | Cytoreduction |205| Prior thrombosis | 3-5x | Anticoagulation |206| JAK2 V617F | 2x | Higher for homozygous |207| High WBC | 1.5-2x | Control counts |208| CV risk factors | Additive | Aggressive management |209210## Special Considerations2112121. **Triple-Negative MPN**: Different prognosis, consider other diagnoses2132. **Cytogenetic Evolution**: High-risk signal, BMB follow-up2143. **New Mutations**: May indicate disease evolution2154. **Treatment Resistance**: Consider second-line or transplant2165. **Quality of Life**: Balance treatment intensity217218## Transplant Indications219220| Indication | Criteria | Timing |221|------------|----------|--------|222| High-Risk PMF | MIPSS70+ high/very high | Consider early |223| Blast Phase | ≥20% blasts | Urgent if fit |224| Refractory Disease | Failed JAKi | Evaluate |225| Transfusion Dependence | RBC/platelet dependent | Factor in decision |226227## Author228229AI Group - Biomedical AI Platform230231232<!-- AUTHOR_SIGNATURE: 9a7f3c2e-MD-BABU-MIA-2026-MSSM-SECURE -->