# MASCC risk index (Klastersky)

MASCC

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

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

## What it computes

Sum the Klastersky 2000 MASCC risk-index weights for febrile neutropenia and return low-risk (≥21) or high-risk (<21).

## When to use

When an agent needs the published MASCC point total and must not invent an outpatient-chemotherapy or admission decision.

## When not to use

- Not a medical device and not an outpatient-chemotherapy, admission, or discharge order. magent does not examine the patient.
- Burden of illness is one caller-assigned value (none_or_mild, moderate, or severe), not cumulative. magent does not grade symptoms from a chart narrative.
- no_hypotension is the published SBP >90 mm Hg criterion as assigned by the caller. magent does not read a blood pressure.
- solid_tumor_or_no_prior_fungal is one item: solid tumor or hematologic malignancy without previous fungal infection (Klastersky 2000). magent does not classify tumor type from histology text.
- Low-risk is score ≥21 (max 26). High-risk is score <21. This is the published index only.

## Formula

```
MASCC = burden (none_or_mild 5, moderate 3, severe 0; one value) + no_hypotension 5 + no_copd 4 + solid_tumor_or_no_prior_fungal 4 + outpatient 3 + no_dehydration 3 + age_lt_60 2; Klastersky 2000; max 26; low-risk ≥21
```

## Citation

[The Multinational Association for Supportive Care in Cancer risk index: a multinational scoring system for identifying low-risk febrile neutropenic cancer patients](https://doi.org/10.1200/JCO.2000.18.16.3038)
Klastersky J, Paesmans M, Rubenstein EB, Boyer M, Elting L, Feld R, Gallagher J, Herrstedt J, Rapoport B, Rolston K, Talcott J
J Clin Oncol. 2000;18(16):3038-3051
DOI: [10.1200/JCO.2000.18.16.3038](https://doi.org/10.1200/JCO.2000.18.16.3038)

## Worked example

### Maximum score, low-risk

Given: `age_lt_60=true, burden=none_or_mild, no_copd=true, no_dehydration=true, no_hypotension=true, outpatient=true, solid_tumor_or_no_prior_fungal=true`

1. Burden none_or_mild → 5
2. no_hypotension → 5; no_copd → 4; solid_tumor_or_no_prior_fungal → 4; outpatient → 3; no_dehydration → 3; age_lt_60 → 2
3. Score = 26 (max 26); mascc_band = low_risk (≥21)


### Severe burden, no protective flags

Given: `age_lt_60=false, burden=severe, no_copd=false, no_dehydration=false, no_hypotension=false, outpatient=false, solid_tumor_or_no_prior_fungal=false`

1. Burden severe → 0; all six flags false → 0
2. Score = 0 (max 26); mascc_band = high_risk (<21)


## Also searched as

- MASCC risk index
- MASCC score
- febrile neutropenia score
- Klastersky MASCC
- neutropenic fever risk
- MASCC index

## Parameters

- `burden` (string, required): Caller-assigned burden of illness (none_or_mild, moderate, or severe). Klastersky 2000: none_or_mild → 5, moderate → 3, severe → 0. One value, not cumulative.
- `no_hypotension` (boolean, required): No hypotension (SBP >90 mm Hg) as assigned by the caller (Klastersky 2000). true scores 5. magent does not read a blood pressure.
- `no_copd` (boolean, required): No COPD as assigned by the caller (Klastersky 2000). true scores 4.
- `solid_tumor_or_no_prior_fungal` (boolean, required): Solid tumor, or hematologic malignancy without previous fungal infection, as assigned by the caller (Klastersky 2000). One item. true scores 4.
- `outpatient` (boolean, required): Outpatient status at fever onset as assigned by the caller (Klastersky 2000). true scores 3.
- `no_dehydration` (boolean, required): No dehydration requiring parenteral fluids as assigned by the caller (Klastersky 2000). true scores 3.
- `age_lt_60` (boolean, required): Age <60 years as assigned by the caller (Klastersky 2000). true scores 2. magent does not parse a numeric age here.

## 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/mascc`
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": [
    {
      "age_lt_60": "true",
      "burden": "none_or_mild",
      "no_copd": "true",
      "no_dehydration": "true",
      "no_hypotension": "true",
      "outpatient": "true",
      "solid_tumor_or_no_prior_fungal": "true"
    },
    {
      "age_lt_60": "true",
      "burden": "none_or_mild",
      "no_copd": "true",
      "no_dehydration": "true",
      "no_hypotension": "true",
      "outpatient": "true",
      "solid_tumor_or_no_prior_fungal": "true"
    }
  ]
}
```

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

Example 200:

```json
{
  "count": 2,
  "path": "/api/calc/mascc",
  "items": [
    {
      "components": [
        {
          "value": "none_or_mild",
          "factor": "burden",
          "points": 5,
          "present": true
        },
        {
          "factor": "no_hypotension",
          "points": 5,
          "present": true
        },
        {
          "factor": "no_copd",
          "points": 4,
          "present": true
        },
        {
          "factor": "solid_tumor_or_no_prior_fungal",
          "points": 4,
          "present": true
        },
        {
          "factor": "outpatient",
          "points": 3,
          "present": true
        },
        {
          "factor": "no_dehydration",
          "points": 3,
          "present": true
        },
        {
          "factor": "age_lt_60",
          "points": 2,
          "present": true
        }
      ],
      "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": "Klastersky J, Paesmans M, Rubenstein EB, Boyer M, Elting L, Feld R, Gallagher J, Herrstedt J, Rapoport B, Rolston K, Talcott J",
        "doi": "10.1200/JCO.2000.18.16.3038",
        "id": "klastersky-2000",
        "pmid": "10944139",
        "source": "J Clin Oncol. 2000;18(16):3038-3051",
        "title": "The Multinational Association for Supportive Care in Cancer risk index: a multinational scoring system for identifying low-risk febrile neutropenic cancer patients"
      },
      "formula": "mascc",
      "formula_expression": "MASCC = burden (none_or_mild 5, moderate 3, severe 0; one value) + no_hypotension 5 + no_copd 4 + solid_tumor_or_no_prior_fungal 4 + outpatient 3 + no_dehydration 3 + age_lt_60 2; Klastersky 2000; max 26; low-risk ≥21",
      "max_score": 26,
      "score": 26,
      "burden": "none_or_mild",
      "mascc_band": "low_risk"
    },
    {
      "components": [
        {
          "value": "none_or_mild",
          "factor": "burden",
          "points": 5,
          "present": true
        },
        {
          "factor": "no_hypotension",
          "points": 5,
          "present": true
        },
        {
          "factor": "no_copd",
          "points": 4,
          "present": true
        },
        {
          "factor": "solid_tumor_or_no_prior_fungal",
          "points": 4,
          "present": true
        },
        {
          "factor": "outpatient",
          "points": 3,
          "present": true
        },
        {
          "factor": "no_dehydration",
          "points": 3,
          "present": true
        },
        {
          "factor": "age_lt_60",
          "points": 2,
          "present": true
        }
      ],
      "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": "Klastersky J, Paesmans M, Rubenstein EB, Boyer M, Elting L, Feld R, Gallagher J, Herrstedt J, Rapoport B, Rolston K, Talcott J",
        "doi": "10.1200/JCO.2000.18.16.3038",
        "id": "klastersky-2000",
        "pmid": "10944139",
        "source": "J Clin Oncol. 2000;18(16):3038-3051",
        "title": "The Multinational Association for Supportive Care in Cancer risk index: a multinational scoring system for identifying low-risk febrile neutropenic cancer patients"
      },
      "formula": "mascc",
      "formula_expression": "MASCC = burden (none_or_mild 5, moderate 3, severe 0; one value) + no_hypotension 5 + no_copd 4 + solid_tumor_or_no_prior_fungal 4 + outpatient 3 + no_dehydration 3 + age_lt_60 2; Klastersky 2000; max 26; low-risk ≥21",
      "max_score": 26,
      "score": 26,
      "burden": "none_or_mild",
      "mascc_band": "low_risk"
    }
  ]
}
```

## Response fields

- `formula` (string): mascc
- `formula_expression` (string): Exact expression used
- `score` (integer): MASCC points 0-26
- `max_score` (integer): Always 26
- `mascc_band` (string): low_risk when score ≥21, high_risk when score <21 (Klastersky 2000). Not an outpatient-chemotherapy order.
- `burden` (string): Caller-assigned burden of illness used (none_or_mild, moderate, or severe)
- `components` (array): Per-factor points
- `citation` (object): Klastersky 2000 J Clin Oncol citation
- `disclaimer` (string): Not-a-device notice

## Example JSON

Frozen fixture. Not a live lookup.

```json
{
  "components": [
    {
      "value": "none_or_mild",
      "factor": "burden",
      "points": 5,
      "present": true
    },
    {
      "factor": "no_hypotension",
      "points": 5,
      "present": true
    },
    {
      "factor": "no_copd",
      "points": 4,
      "present": true
    },
    {
      "factor": "solid_tumor_or_no_prior_fungal",
      "points": 4,
      "present": true
    },
    {
      "factor": "outpatient",
      "points": 3,
      "present": true
    },
    {
      "factor": "no_dehydration",
      "points": 3,
      "present": true
    },
    {
      "factor": "age_lt_60",
      "points": 2,
      "present": true
    }
  ],
  "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": "Klastersky J, Paesmans M, Rubenstein EB, Boyer M, Elting L, Feld R, Gallagher J, Herrstedt J, Rapoport B, Rolston K, Talcott J",
    "doi": "10.1200/JCO.2000.18.16.3038",
    "id": "klastersky-2000",
    "pmid": "10944139",
    "source": "J Clin Oncol. 2000;18(16):3038-3051",
    "title": "The Multinational Association for Supportive Care in Cancer risk index: a multinational scoring system for identifying low-risk febrile neutropenic cancer patients"
  },
  "formula": "mascc",
  "formula_expression": "MASCC = burden (none_or_mild 5, moderate 3, severe 0; one value) + no_hypotension 5 + no_copd 4 + solid_tumor_or_no_prior_fungal 4 + outpatient 3 + no_dehydration 3 + age_lt_60 2; Klastersky 2000; max 26; low-risk ≥21",
  "max_score": 26,
  "score": 26,
  "burden": "none_or_mild",
  "mascc_band": "low_risk"
}
```

## Errors

- HTTP 400 `invalid_mascc_burden`: burden must be none_or_mild, moderate, or severe (Klastersky 2000 MASCC; not cumulative). 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

- [ANC](https://magentlab.com/docs/anc) — Compute absolute neutrophil count from WBC and neutrophil plus band percents, plus a Bodey 1966 granulocyte band.
- [SIRS](https://magentlab.com/docs/sirs) — Compute the Bone 1992 ACCP/SCCM SIRS criteria from temperature, heart rate, respiratory rate, and WBC, with optional PaCO2 and band percent.
- [qSOFA](https://magentlab.com/docs/qsofa) — Compute the Sepsis-3 qSOFA score from respiratory rate, caller-assigned altered mentation, and systolic blood pressure.

## 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.
- 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.