Ausgangsorgan Dysfunktion, die Standard MCL Induktion (Nordic R-MaxiCHOP/AraC, R-D...

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

ID	`RF-MCL-ORGAN-DYSFUNCTION`
Art	Warnhinweis
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Erkrankungen	`DIS-MCL`
Quellen	`SRC-ESMO-MCL-2024` `SRC-NCCN-BCELL-2025`

Ursprung der Roten Flagge

Begriffsbestimmung	Baseline organ dysfunction precluding standard MCL induction (Nordic R-MaxiCHOP/AraC, R-DHAP, R-CHOP, BR): LVEF <50% (R-CHOP / R-DHAP anthracycline contraindicated), CrCl <50 (HD-cytarabine in Nordic / R-DHAP requires renal function — neurotoxicity risk; CrCl <30 absolute contraindication), bilirubin >3× ULN, severe cardiac dysfunction (ibrutinib relative contraindication), or active bleeding diathesis.
Klinische Richtung	Eskalation
Kategorie	Organdysfunktion

Logik auslösen

{
  "any_of": [
    {
      "comparator": "<",
      "finding": "lvef_percent",
      "threshold": 50
    },
    {
      "comparator": "<",
      "finding": "creatinine_clearance_ml_min",
      "threshold": 50
    },
    {
      "comparator": ">=",
      "finding": "bilirubin_ratio_to_uln",
      "threshold": 3
    },
    {
      "finding": "nyha_class_3_or_4",
      "value": true
    },
    {
      "finding": "active_bleeding",
      "value": true
    }
  ],
  "type": "lab_value"
}

Anmerkungen

HD-cytarabine (>2 g/m² per dose in Nordic, R-DHAP) is the cerebellar-toxicity-limiting drug — CrCl <50 mandates dose reduction (1 g/m² instead of 2-3 g/m²); CrCl <30 absolute contraindication. LVEF <50%: avoid R-CHOP backbone — use BR (StiL NHL1 — bendamustine + R, no anthracycline); for fit younger transplant candidates with LVEF 40-50%, R-DHAP without anthracycline acceptable as transplant bridge. Cardiac comorbidity + intended BTKi: zanubrutinib / acalabrutinib preferred over ibrutinib (lower AF / HTN per ALPINE / ELEVATE-RR data).

Verwendet von

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