# BALL score for relapsed-refractory CLL BALL score Status: LIVE Price: $0.005 USDC `GET /api/calc/ball` HTML: https://magentlab.com/docs/ball Markdown: https://magentlab.com/docs/ball.md Not a medical device. Not a diagnosis, dose, or listing recommendation. ## What it computes Sum the four Soumerai 2019 BALL flags for relapsed or refractory CLL and return score 0–4 with risk low (0–1), intermediate (2–3), or high (4). ## When to use When an agent already has caller-assigned Soumerai 2019 BALL flags and needs the published 0–4 total and risk band, not a CLL treatment recommendation, lab assay, or invented overall-survival percent. ## When not to use - Not a medical device and not a treatment recommendation. magent does not assay labs. - b2m_ge_5 is a caller-assigned flag. The paper’s cutoff string is ≥5 mg/dL (Lancet Haematol 2019 abstract). Some later summaries print mg/L; magent does not convert mg/L versus mg/dL and does not assay β2-microglobulin. - anemia is a caller-assigned flag using hemoglobin <110 g/L in women or <120 g/L in men. magent does not take a hemoglobin number or sex. - ldh_gt_uln and last_therapy_lt_24mo are caller-assigned flags. magent does not assay LDH or read a treatment calendar. ## Formula ``` BALL = b2m_ge_5 + ldh_gt_uln + anemia + last_therapy_lt_24mo; each 1; Soumerai 2019; max 4; low 0-1, intermediate 2-3, high 4 ``` ## Citation [Prognostic risk score for patients with relapsed or refractory chronic lymphocytic leukaemia treated with targeted therapies or chemoimmunotherapy: a retrospective, pooled cohort study with external validations](https://doi.org/10.1016/S2352-3026(19)30085-7) Soumerai JD, Ni A, Darif M, Londhe A, Xing G, Mun Y, et al. Lancet Haematol. 2019;6(7):e366-e374 DOI: [10.1016/S2352-3026(19)30085-7](https://doi.org/10.1016/S2352-3026(19)30085-7) ## Worked example ### All flags false Given: `anemia=false, b2m_ge_5=false, last_therapy_lt_24mo=false, ldh_gt_uln=false` 1. b2m_ge_5, ldh_gt_uln, anemia, and last_therapy_lt_24mo are false 2. score = 0 (max 4); risk = low ### All four flags true Given: `anemia=true, b2m_ge_5=true, last_therapy_lt_24mo=true, ldh_gt_uln=true` 1. All four Soumerai 2019 flags true, 1 point each 2. score = 4 (max 4); risk = high ## Also searched as - BALL score - BALL CLL - Soumerai BALL - relapsed refractory CLL score - BALL prognostic score - beta-2-microglobulin CLL score - R/R CLL BALL ## Parameters - `b2m_ge_5` (boolean, required): Serum β2-microglobulin at or above the Soumerai 2019 published cutoff (≥5 mg/dL) as assigned by the caller. true or false. magent does not assay B2M and does not convert mg/L versus mg/dL. - `ldh_gt_uln` (boolean, required): Serum LDH above the laboratory upper limit of normal as assigned by the caller (Soumerai 2019). true or false. magent does not assay LDH. - `anemia` (boolean, required): Anemia as assigned by the caller using Soumerai 2019 hemoglobin cutoffs (hemoglobin <110 g/L in women or <120 g/L in men). true or false. magent does not take a hemoglobin number or sex and does not assay hemoglobin. - `last_therapy_lt_24mo` (boolean, required): Time from initiation of last therapy <24 months as assigned by the caller (Soumerai 2019). true or false. magent does not read a treatment calendar. ## Bulk (POST) POST the same path with a JSON items array. The first item is the GET unit; each additional item is $0.002. Invalid items return HTTP 400 before settlement. Method: `POST /api/calc/ball` Max items: 25 Price: unit_amount + extra_item_amount * (n - 1) (unit 5000 atomic, extra 2000 atomic) Status: PREVIEW - 1 to 25 items. Each item uses the same keys as the GET query parameters. - POST of 1 item costs the same as GET. Lists longer than 25: chunk into multiple POSTs. Extra items still execute; do not pad dummy rows. - The first invalid item fails the whole request (index in the 400 JSON). You are not charged. - HTTP 200 is {count, path, items}. Each items[i] is the GET 200 body for that row. - Catalog misses (empty matches, found=false) stay paid 200s inside that slot. - x402 resource URL is this path plus n and body_sha256. Browsers that prefer text/html get the same paywall as GET; Pay retries POST with the same items. Example request: ```json { "items": [ { "anemia": "false", "b2m_ge_5": "false", "last_therapy_lt_24mo": "false", "ldh_gt_uln": "false" }, { "anemia": "false", "b2m_ge_5": "false", "last_therapy_lt_24mo": "false", "ldh_gt_uln": "false" } ] } ``` Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/ball Example 200: ```json { "count": 2, "path": "/api/calc/ball", "items": [ { "components": [ { "factor": "b2m_ge_5", "points": 0, "present": false }, { "factor": "ldh_gt_uln", "points": 0, "present": false }, { "factor": "anemia", "points": 0, "present": false }, { "factor": "last_therapy_lt_24mo", "points": 0, "present": false } ], "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.", "citation": { "authors": "Soumerai JD, Ni A, Darif M, Londhe A, Xing G, Mun Y, et al.", "doi": "10.1016/S2352-3026(19)30085-7", "id": "soumerai-2019", "pmid": "31109827", "source": "Lancet Haematol. 2019;6(7):e366-e374", "title": "Prognostic risk score for patients with relapsed or refractory chronic lymphocytic leukaemia treated with targeted therapies or chemoimmunotherapy: a retrospective, pooled cohort study with external validations" }, "formula": "ball", "formula_expression": "BALL = b2m_ge_5 + ldh_gt_uln + anemia + last_therapy_lt_24mo; each 1; Soumerai 2019; max 4; low 0-1, intermediate 2-3, high 4", "max_score": 4, "score": 0, "risk": "low" }, { "components": [ { "factor": "b2m_ge_5", "points": 0, "present": false }, { "factor": "ldh_gt_uln", "points": 0, "present": false }, { "factor": "anemia", "points": 0, "present": false }, { "factor": "last_therapy_lt_24mo", "points": 0, "present": false } ], "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.", "citation": { "authors": "Soumerai JD, Ni A, Darif M, Londhe A, Xing G, Mun Y, et al.", "doi": "10.1016/S2352-3026(19)30085-7", "id": "soumerai-2019", "pmid": "31109827", "source": "Lancet Haematol. 2019;6(7):e366-e374", "title": "Prognostic risk score for patients with relapsed or refractory chronic lymphocytic leukaemia treated with targeted therapies or chemoimmunotherapy: a retrospective, pooled cohort study with external validations" }, "formula": "ball", "formula_expression": "BALL = b2m_ge_5 + ldh_gt_uln + anemia + last_therapy_lt_24mo; each 1; Soumerai 2019; max 4; low 0-1, intermediate 2-3, high 4", "max_score": 4, "score": 0, "risk": "low" } ] } ``` ## Response fields - `formula` (string): ball - `formula_expression` (string): Exact expression used - `score` (integer): BALL points 0-4 - `max_score` (integer): Always 4 - `risk` (string): low when score is 0-1, intermediate when 2-3, high when 4 (Soumerai 2019). Not a treatment recommendation. Not overall-survival percents. - `components` (array): Per-factor points - `citation` (object): Soumerai 2019 Lancet Haematol citation - `disclaimer` (string): Not-a-device notice ## Example JSON Frozen fixture. Not a live lookup. ```json { "components": [ { "factor": "b2m_ge_5", "points": 0, "present": false }, { "factor": "ldh_gt_uln", "points": 0, "present": false }, { "factor": "anemia", "points": 0, "present": false }, { "factor": "last_therapy_lt_24mo", "points": 0, "present": false } ], "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.", "citation": { "authors": "Soumerai JD, Ni A, Darif M, Londhe A, Xing G, Mun Y, et al.", "doi": "10.1016/S2352-3026(19)30085-7", "id": "soumerai-2019", "pmid": "31109827", "source": "Lancet Haematol. 2019;6(7):e366-e374", "title": "Prognostic risk score for patients with relapsed or refractory chronic lymphocytic leukaemia treated with targeted therapies or chemoimmunotherapy: a retrospective, pooled cohort study with external validations" }, "formula": "ball", "formula_expression": "BALL = b2m_ge_5 + ldh_gt_uln + anemia + last_therapy_lt_24mo; each 1; Soumerai 2019; max 4; low 0-1, intermediate 2-3, high 4", "max_score": 4, "score": 0, "risk": "low" } ``` ## Errors - HTTP 400 `invalid_ball`: BALL score inputs must match Soumerai 2019 beta-2-microglobulin, LDH, hemoglobin, and time-from-last-therapy flags from that paper. Returned before settlement; you are not charged. - HTTP 400 `invalid_items`: POST body must be a JSON object with only an items array Returned before settlement; you are not charged. - HTTP 400 `invalid_item_count`: items must be an array of 1 to 25 objects Returned before settlement; you are not charged. - HTTP 400 `invalid_item`: each items entry must be a JSON object Returned before settlement; you are not charged. Shared HTTP 402 and 503: https://magentlab.com/docs/payments ## Related tools - [IPI](https://magentlab.com/docs/ipi) — Sum the Shipp 1993 five-factor International Prognostic Index (all ages) and return low (0–1), low_intermediate (2), high_intermediate (3), or high (4–5). ## Payment Unpaid requests return HTTP 402 even if query parameters or POST items are missing or invalid, so CDP and agents can index the path. After a PAYMENT-SIGNATURE, invalid params return HTTP 400 JSON before settlement. magent does not charge. Fix the params, then request a new 402 quote for that complete URL. Catalog misses (empty matches, found=false) are valid paid 200s. - GET the tool with Accept: application/json (do not send Accept: text/html unless you want the human paywall). - HTTP 402 means you have not paid. Decode the base64 PAYMENT-REQUIRED header. HTTP 503 is not a new quote. - Sign accepts[0] (exact, EIP-3009) with validBefore = now + maxTimeoutSeconds (600 seconds), or accepts[1] (batch-settlement deposit/voucher) on product GET. Ping and POST {items} stay exact. Magent retries transient facilitator 429/5xx before answering. - Retry the same URL with PAYMENT-SIGNATURE (base64 JSON of accepted and payload). Magent attaches canonical extensions.bazaar on CDP verify/settle; echoing 402 bazaar is optional. - Success is HTTP 200 JSON plus PAYMENT-RESPONSE. exact settles before the tool. batch-settlement verifies (and deposit-settles) before the tool and commits the charge after HTTP 2xx. HTTP 503: retry the same PAYMENT-SIGNATURE. Mint a new exact nonce only after a new HTTP 402. - offered `exact` on eip155:8453: Fixed-price USDC on Base. The buyer authorizes the advertised amount (EIP-3009). magent settles before the tool runs (paymentFlow upfront). extra.assetTransferMethod=eip3009 extra.paymentFlow=upfront. - offered `batch-settlement` on eip155:8453: Payment-channel vouchers claimed later in batches. Exact stays accepts[0]. Same-path POST {items} is still exact. extra.assetTransferMethod=eip3009 extra.paymentFlow=authorization. - not offered `upto`: Not offered. Usage-based: buyer authorizes a ceiling, seller settles the actual amount after work. Reserved for a future metered tool. Not for current calculators or code search. Same-path POST {items} is still scheme exact: one EIP-3009 authorization for GET unit plus $0.002 per extra item. That is not x402 batch-settlement (payment channels / vouchers). Shared HTTP 402 and 503 table: https://magentlab.com/docs/payments Stdio MCP (one process per host): https://magentlab.com/docs/mcp ## Guarantees - HTTP 402 is unpaid, including a missing query. After PAYMENT-SIGNATURE, invalid parameters return HTTP 400 before settlement. You are not charged. HTTP 402 never includes the tool JSON. - exact: settlement finishes before the tool (paymentFlow upfront). batch-settlement: verify/deposit before the tool; chargedCumulativeAmount commits after HTTP 2xx. Uncertain or failed settlement fails closed (HTTP 503). Retry the same PAYMENT-SIGNATURE. - HTTP 402 is unpaid only. Do not sign a second authorization because of a 503. - Execution is timeout-bounded and concurrency-capped. - Calculator inputs are stored encrypted for allowlisted operators (Magent Console). They are not in public logs, SSH lookups, catalog, or rollups. Request logs store path without query.