# ICC 2022 primary myelofibrosis criteria

ICC 2022 PMF criteria

Status: LIVE
Price: $0.005 USDC
`GET /api/calc/icc_pmf`
HTML: https://magentlab.com/docs/icc-pmf
Markdown: https://magentlab.com/docs/icc-pmf.md

Not a medical device. Not a diagnosis, dose, or listing recommendation.

## What it computes

Apply the Arber 2022 International Consensus Classification prefibrotic and overt primary myelofibrosis criteria and return whether all three majors and at least one applicable minor are met. Leukoerythroblastosis counts only for overt PMF.

## When to use

When an agent already has caller-assigned ICC 2022 PMF phenotype and major/minor flags and needs the published criteria result. magent does not diagnose PMF, does not read fibrosis grade, and does not sequence JAK2, CALR, or MPL.

## When not to use

- Not a medical device.
- Not a diagnosis. Criteria met is not a primary myelofibrosis diagnosis without the rest of the ICC 2022 workup.
- Not DIPSS, DIPSS Plus, MIPSS70, or MIPSS70-plus. This tool is ICC 2022 diagnostic criteria, not a prognostic score.
- Not WHO 5th edition / Khoury 2022 classification.
- Not post-PV or post-ET myelofibrosis. This tool is ICC 2022 primary myelofibrosis only (prefibrotic and overt).
- magent does not read a biopsy or fibrosis grade. megakaryocyte_morphology is assigned by the caller for the chosen phenotype.
- magent does not sequence JAK2, CALR, MPL, or other clonal markers. clonal_or_no_reactive is caller-assigned.

## Formula

```
diagnosed iff three majors and minor_count ≥ 1; majors are megakaryocyte_morphology, not_other_myeloid, and clonal_or_no_reactive; minor_count is anemia_not_comorbid + leukocytosis_ge_11 + splenomegaly + ldh_above_uln + leukoerythroblastosis only when phenotype is overt (Arber 2022 ICC pre-PMF and overt PMF). Not DIPSS. Not WHO 5th. Not post-PV/post-ET myelofibrosis
```

## Citation

[International Consensus Classification of Myeloid Neoplasms and Acute Leukemias: integrating morphologic, clinical, and genomic data](https://doi.org/10.1182/blood.2022015850)
Arber DA, Orazi A, Hasserjian RP, Borowitz MJ, Calvo KR, Kvasnicka HM, Wang SA, Bagg A, Barbui T, Bennett JM, de la Fuente J, et al.
Blood. 2022;140(11):1200-1228
DOI: [10.1182/blood.2022015850](https://doi.org/10.1182/blood.2022015850)

## Worked example

### Prefibrotic PMF with anemia minor

Given: `anemia_not_comorbid=true, clonal_or_no_reactive=true, ldh_above_uln=false, leukocytosis_ge_11=false, leukoerythroblastosis=false, megakaryocyte_morphology=true, not_other_myeloid=true, phenotype=pre, splenomegaly=false`

1. phenotype is pre; all three majors true → major_count 3
2. anemia_not_comorbid true; remaining shared minors false; leukoerythroblastosis false → minor_count 1
3. diagnosed true (three majors and at least one applicable minor)


### Overt PMF with leukoerythroblastosis only

Given: `anemia_not_comorbid=false, clonal_or_no_reactive=true, ldh_above_uln=false, leukocytosis_ge_11=false, leukoerythroblastosis=true, megakaryocyte_morphology=true, not_other_myeloid=true, phenotype=overt, splenomegaly=false`

1. phenotype is overt; all three majors true → major_count 3
2. shared minors false; leukoerythroblastosis true → minor_count 1 (overt minor)
3. diagnosed true


### Three majors without a counted minor

Given: `anemia_not_comorbid=false, clonal_or_no_reactive=true, ldh_above_uln=false, leukocytosis_ge_11=false, leukoerythroblastosis=false, megakaryocyte_morphology=true, not_other_myeloid=true, phenotype=pre, splenomegaly=false`

1. phenotype is pre; all three majors true → major_count 3
2. all minors false → minor_count 0
3. diagnosed false (need at least one applicable minor)


### Prefibrotic PMF ignores leukoerythroblastosis

Given: `anemia_not_comorbid=false, clonal_or_no_reactive=true, ldh_above_uln=false, leukocytosis_ge_11=false, leukoerythroblastosis=true, megakaryocyte_morphology=true, not_other_myeloid=true, phenotype=pre, splenomegaly=false`

1. phenotype is pre; all three majors true → major_count 3
2. leukoerythroblastosis true is echoed but does not count; shared minors false → minor_count 0
3. diagnosed false (ICC: leukoerythroblastosis is an overt-PMF minor)


## Also searched as

- ICC 2022 primary myelofibrosis
- prefibrotic PMF diagnostic criteria
- overt PMF ICC 2022
- Arber 2022 myeloid neoplasms PMF
- pre-PMF megakaryocyte atypia
- JAK2 CALR MPL primary myelofibrosis
- ICC prefibrotic versus overt PMF
- reticulin fibrosis grade 2 PMF

## Parameters

- `phenotype` (string, required): pre (prefibrotic/early PMF) or overt (overt fibrotic PMF) as assigned by the caller (Arber 2022 ICC). Required. magent does not assign phenotype from a biopsy.
- `megakaryocyte_morphology` (boolean, required): Megakaryocytic proliferation and atypia for the chosen phenotype, as assigned by the caller (Arber 2022 ICC PMF major). For pre: without reticulin fibrosis grade >1, with increased age-adjusted cellularity, granulocytic proliferation, and often decreased erythropoiesis. For overt: accompanied by reticulin and/or collagen fibrosis grade 2 or 3. true or false. magent does not read a biopsy.
- `not_other_myeloid` (boolean, required): Does not meet ICC/WHO criteria for BCR::ABL1-positive CML, PV, ET, MDS, or another defined myeloid neoplasm, as assigned by the caller (Arber 2022 ICC PMF major). true or false. magent does not diagnose those neoplasms.
- `clonal_or_no_reactive` (boolean, required): JAK2, CALR, or MPL mutation, or another clonal marker, or absence of reactive bone-marrow fibrosis, as assigned by the caller (Arber 2022 ICC PMF major). true or false. magent does not sequence.
- `anemia_not_comorbid` (boolean, required): Anemia not attributed to a comorbid condition, as assigned by the caller (Arber 2022 ICC PMF minor). true or false. magent does not assay hemoglobin.
- `leukocytosis_ge_11` (boolean, required): Leukocytosis ≥11 × 10^9/L as assigned by the caller (Arber 2022 ICC PMF minor). true or false. magent does not assay WBC.
- `splenomegaly` (boolean, required): Palpable splenomegaly as assigned by the caller (Arber 2022 ICC PMF minor). true or false. magent does not examine the spleen.
- `ldh_above_uln` (boolean, required): LDH above the institutional upper limit of normal as assigned by the caller (Arber 2022 ICC PMF minor). true or false. magent does not assay LDH.
- `leukoerythroblastosis` (boolean, required): Leukoerythroblastosis as assigned by the caller (Arber 2022 ICC overt-PMF minor). Counts toward minor_count only when phenotype is overt; echoed but not counted when phenotype is pre. true or false. magent does not read a smear.

## 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/icc_pmf`
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_not_comorbid": "true",
      "clonal_or_no_reactive": "true",
      "ldh_above_uln": "false",
      "leukocytosis_ge_11": "false",
      "leukoerythroblastosis": "false",
      "megakaryocyte_morphology": "true",
      "not_other_myeloid": "true",
      "phenotype": "pre",
      "splenomegaly": "false"
    },
    {
      "anemia_not_comorbid": "true",
      "clonal_or_no_reactive": "true",
      "ldh_above_uln": "false",
      "leukocytosis_ge_11": "false",
      "leukoerythroblastosis": "false",
      "megakaryocyte_morphology": "true",
      "not_other_myeloid": "true",
      "phenotype": "pre",
      "splenomegaly": "false"
    }
  ]
}
```

Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/icc-pmf

Example 200:

```json
{
  "count": 2,
  "path": "/api/calc/icc_pmf",
  "items": [
    {
      "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": "Arber DA, Orazi A, Hasserjian RP, Borowitz MJ, Calvo KR, Kvasnicka HM, Wang SA, Bagg A, Barbui T, Bennett JM, de la Fuente J, et al.",
        "doi": "10.1182/blood.2022015850",
        "id": "arber-2022",
        "pmid": "35767897",
        "source": "Blood. 2022;140(11):1200-1228",
        "title": "International Consensus Classification of Myeloid Neoplasms and Acute Leukemias: integrating morphologic, clinical, and genomic data"
      },
      "formula": "icc_pmf",
      "formula_expression": "diagnosed iff three majors and minor_count ≥ 1; majors are megakaryocyte_morphology, not_other_myeloid, and clonal_or_no_reactive; minor_count is anemia_not_comorbid + leukocytosis_ge_11 + splenomegaly + ldh_above_uln + leukoerythroblastosis only when phenotype is overt (Arber 2022 ICC pre-PMF and overt PMF). Not DIPSS. Not WHO 5th. Not post-PV/post-ET myelofibrosis",
      "criteria": [
        {
          "factor": "megakaryocyte_morphology",
          "met": true
        },
        {
          "factor": "not_other_myeloid",
          "met": true
        },
        {
          "factor": "clonal_or_no_reactive",
          "met": true
        },
        {
          "factor": "anemia_not_comorbid",
          "met": true
        },
        {
          "factor": "leukocytosis_ge_11",
          "met": false
        },
        {
          "factor": "splenomegaly",
          "met": false
        },
        {
          "factor": "ldh_above_uln",
          "met": false
        },
        {
          "factor": "leukoerythroblastosis",
          "met": false
        },
        {
          "factor": "three_majors",
          "met": true
        },
        {
          "factor": "minor_count_ge_1",
          "met": true
        }
      ],
      "phenotype": "pre",
      "major_count": 3,
      "minor_count": 1,
      "anemia_not_comorbid": true,
      "clonal_or_no_reactive": true,
      "diagnosed": true,
      "ldh_above_uln": false,
      "leukocytosis_ge_11": false,
      "leukoerythroblastosis": false,
      "megakaryocyte_morphology": true,
      "not_other_myeloid": true,
      "splenomegaly": 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": "Arber DA, Orazi A, Hasserjian RP, Borowitz MJ, Calvo KR, Kvasnicka HM, Wang SA, Bagg A, Barbui T, Bennett JM, de la Fuente J, et al.",
        "doi": "10.1182/blood.2022015850",
        "id": "arber-2022",
        "pmid": "35767897",
        "source": "Blood. 2022;140(11):1200-1228",
        "title": "International Consensus Classification of Myeloid Neoplasms and Acute Leukemias: integrating morphologic, clinical, and genomic data"
      },
      "formula": "icc_pmf",
      "formula_expression": "diagnosed iff three majors and minor_count ≥ 1; majors are megakaryocyte_morphology, not_other_myeloid, and clonal_or_no_reactive; minor_count is anemia_not_comorbid + leukocytosis_ge_11 + splenomegaly + ldh_above_uln + leukoerythroblastosis only when phenotype is overt (Arber 2022 ICC pre-PMF and overt PMF). Not DIPSS. Not WHO 5th. Not post-PV/post-ET myelofibrosis",
      "criteria": [
        {
          "factor": "megakaryocyte_morphology",
          "met": true
        },
        {
          "factor": "not_other_myeloid",
          "met": true
        },
        {
          "factor": "clonal_or_no_reactive",
          "met": true
        },
        {
          "factor": "anemia_not_comorbid",
          "met": true
        },
        {
          "factor": "leukocytosis_ge_11",
          "met": false
        },
        {
          "factor": "splenomegaly",
          "met": false
        },
        {
          "factor": "ldh_above_uln",
          "met": false
        },
        {
          "factor": "leukoerythroblastosis",
          "met": false
        },
        {
          "factor": "three_majors",
          "met": true
        },
        {
          "factor": "minor_count_ge_1",
          "met": true
        }
      ],
      "phenotype": "pre",
      "major_count": 3,
      "minor_count": 1,
      "anemia_not_comorbid": true,
      "clonal_or_no_reactive": true,
      "diagnosed": true,
      "ldh_above_uln": false,
      "leukocytosis_ge_11": false,
      "leukoerythroblastosis": false,
      "megakaryocyte_morphology": true,
      "not_other_myeloid": true,
      "splenomegaly": false
    }
  ]
}
```

## Response fields

- `formula` (string): icc_pmf
- `formula_expression` (string): Arber 2022 ICC pre-PMF and overt PMF major/minor combination
- `phenotype` (string): pre or overt used
- `diagnosed` (boolean): true iff all three majors and minor_count ≥ 1. Not a diagnosis. Not DIPSS. Not WHO 5th / Khoury. Not post-PV/post-ET myelofibrosis.
- `major_count` (integer): Count of megakaryocyte_morphology, not_other_myeloid, and clonal_or_no_reactive that are true
- `minor_count` (integer): Count of anemia_not_comorbid, leukocytosis_ge_11, splenomegaly, and ldh_above_uln that are true, plus leukoerythroblastosis only when phenotype is overt
- `megakaryocyte_morphology` (boolean): Caller-assigned megakaryocyte morphology major for the chosen phenotype
- `not_other_myeloid` (boolean): Caller-assigned not-another-defined-myeloid-neoplasm major used
- `clonal_or_no_reactive` (boolean): Caller-assigned clonal marker or no reactive fibrosis major used
- `anemia_not_comorbid` (boolean): Caller-assigned anemia-not-from-comorbidity minor used
- `leukocytosis_ge_11` (boolean): Caller-assigned leukocytosis ≥11 × 10^9/L minor used
- `splenomegaly` (boolean): Caller-assigned palpable splenomegaly minor used
- `ldh_above_uln` (boolean): Caller-assigned LDH above ULN minor used
- `leukoerythroblastosis` (boolean): Caller-assigned leukoerythroblastosis flag echoed; counted as a minor only when phenotype is overt
- `criteria` (array): Per-factor rows with factor and met for the three majors, four shared minors, leukoerythroblastosis, three_majors, and minor_count_ge_1
- `citation` (object): Arber 2022 Blood ICC PMF citation
- `disclaimer` (string): Not-a-device notice

## Example JSON

Frozen fixture. Not a live lookup.

```json
{
  "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": "Arber DA, Orazi A, Hasserjian RP, Borowitz MJ, Calvo KR, Kvasnicka HM, Wang SA, Bagg A, Barbui T, Bennett JM, de la Fuente J, et al.",
    "doi": "10.1182/blood.2022015850",
    "id": "arber-2022",
    "pmid": "35767897",
    "source": "Blood. 2022;140(11):1200-1228",
    "title": "International Consensus Classification of Myeloid Neoplasms and Acute Leukemias: integrating morphologic, clinical, and genomic data"
  },
  "formula": "icc_pmf",
  "formula_expression": "diagnosed iff three majors and minor_count ≥ 1; majors are megakaryocyte_morphology, not_other_myeloid, and clonal_or_no_reactive; minor_count is anemia_not_comorbid + leukocytosis_ge_11 + splenomegaly + ldh_above_uln + leukoerythroblastosis only when phenotype is overt (Arber 2022 ICC pre-PMF and overt PMF). Not DIPSS. Not WHO 5th. Not post-PV/post-ET myelofibrosis",
  "criteria": [
    {
      "factor": "megakaryocyte_morphology",
      "met": true
    },
    {
      "factor": "not_other_myeloid",
      "met": true
    },
    {
      "factor": "clonal_or_no_reactive",
      "met": true
    },
    {
      "factor": "anemia_not_comorbid",
      "met": true
    },
    {
      "factor": "leukocytosis_ge_11",
      "met": false
    },
    {
      "factor": "splenomegaly",
      "met": false
    },
    {
      "factor": "ldh_above_uln",
      "met": false
    },
    {
      "factor": "leukoerythroblastosis",
      "met": false
    },
    {
      "factor": "three_majors",
      "met": true
    },
    {
      "factor": "minor_count_ge_1",
      "met": true
    }
  ],
  "phenotype": "pre",
  "major_count": 3,
  "minor_count": 1,
  "anemia_not_comorbid": true,
  "clonal_or_no_reactive": true,
  "diagnosed": true,
  "ldh_above_uln": false,
  "leukocytosis_ge_11": false,
  "leukoerythroblastosis": false,
  "megakaryocyte_morphology": true,
  "not_other_myeloid": true,
  "splenomegaly": false
}
```

## Errors

- HTTP 400 `invalid_pmf_phenotype`: phenotype must be pre or overt (Arber 2022 ICC prefibrotic versus overt primary myelofibrosis). Returned before settlement; you are not charged.
- HTTP 400 `invalid_flag`: boolean clinical flags must be true or false 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

- [DIPSS](https://magentlab.com/docs/dipss) — Sum the Passamonti 2010 DIPSS (dynamic international prognostic scoring system) for primary myelofibrosis and return low (0), intermediate_1 (1–2), intermediate_2 (3–4), or high (5–6).
- [GIPSS](https://magentlab.com/docs/gipss) — Sum the Tefferi 2018 GIPSS (genetically inspired prognostic scoring system) for primary myelofibrosis and return low (0), intermediate_1 (1), intermediate_2 (2), or high (≥3).

## 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.