Ausgangsorgan Dysfunktion, die Standard-R-CHOP-Dosen: LVEF < 50% (Anthracyclin con...

Deterministische Ansicht der Quelle YAML Entität. Klinische Autorität bleibt mit den zitierten Quell-IDs und Rezensenten Sign-off Zustand.

ID	`RF-DLBCL-ORGAN-DYSFUNCTION`
Art	Warnhinweis
Status	reviewed 2026-04-25 \| pending_clinical_signoff
Erkrankungen	`DIS-DLBCL-NOS`
Quellen	`SRC-ESMO-DLBCL-2024` `SRC-NCCN-BCELL-2025`

Ursprung der Roten Flagge

Begriffsbestimmung	Baseline organ dysfunction precluding standard R-CHOP doses: LVEF <50% (anthracycline contraindicated), CrCl <30 mL/min (severe cyclophosphamide / methotrexate dose constraints), bilirubin >3× ULN (vincristine / doxorubicin metabolism), or DLCO <60% (lung-toxicity risk on CHOP-based therapy).
Klinische Richtung	Eskalation
Kategorie	Organdysfunktion
Schaltet Algorithmus	ALGO-DLBCL-1L

Logik auslösen

{
  "any_of": [
    {
      "comparator": "<",
      "finding": "lvef_percent",
      "threshold": 50
    },
    {
      "comparator": "<",
      "finding": "creatinine_clearance_ml_min",
      "threshold": 30
    },
    {
      "comparator": ">=",
      "finding": "bilirubin_ratio_to_uln",
      "threshold": 3
    },
    {
      "comparator": "<",
      "finding": "dlco_percent",
      "threshold": 60
    }
  ],
  "type": "lab_value"
}

Anmerkungen

LVEF <50%: substitute liposomal doxorubicin or omit anthracycline (R-CEOP using etoposide; or R-GCVP). CrCl <30: cyclophosphamide reduce 25-50% per institutional renal-dosing protocol; HD-MTX contraindicated for CNS prophylaxis (use IT only). DLCO <60%: document baseline carefully; pulmonary toxicity is uncommon at standard CHOP cycles but accumulates at salvage. This RF de-escalates toward R-CHOP standard from Pola-R-CHP intensification when both fire (high IPI + organ dysfunction common in elderly).

Verwendet von

Algorithmen

ALGO-DLBCL-1L - ALGO-DLBCL-1L
ALGO-DLBCL-2L - ALGO-DLBCL-2L

Kapitel des Handbuchs

HB-DLBCL-1L - Diffuse große B-Zell-Lymphom: First-Line-Reinigung

Handbuchfragen

HQ-DLBCL-1L-002 - HQ-DLBCL-1L-002