Age-adjusted IPI ≥2 in patient <60 yo — high-risk young-adult DLBCL; supports DA-EPOCH-R...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-AAIPI-HIGH`
Type	Red flag
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	`DIS-DLBCL-NOS`
Sources	`SRC-ESMO-DLBCL-2024` `SRC-NCCN-BCELL-2025`

Red Flag Origin

Definition	Age-adjusted IPI ≥2 in patient <60 yo — high-risk young-adult DLBCL; supports DA-EPOCH-R consideration over R-CHOP per CALGB 50303 / Wilson and AYA-DLBCL series
Clinical direction	intensify
Category	risk-score

Trigger Logic

{
  "all_of": [
    {
      "comparator": "<",
      "finding": "age_years",
      "threshold": 60
    },
    {
      "any_of": [
        {
          "comparator": ">=",
          "finding": "aaipi_score",
          "threshold": 2
        },
        {
          "finding": "aaipi_risk_group",
          "value": "high"
        },
        {
          "finding": "aaipi_risk_group",
          "value": "high_intermediate"
        }
      ]
    }
  ],
  "type": "composite_score"
}

Notes

Age-adjusted IPI (Shipp 1993) uses 3 factors (stage III-IV, LDH>ULN, ECOG ≥2) and was validated in <60 yo; aaIPI ≥2 marks the high/high-intermediate cohort with R-CHOP 5-yr OS ~50-60%. CALGB 50303 did not show DA-EPOCH-R superiority over R-CHOP overall but retrospective and HIV-DLBCL data favor DA-EPOCH-R in younger high-risk patients with double-hit / MYC-rearrangement (handled separately by RF-DLBCL-HIGH-RISK-BIOLOGY). Kept as a discussion trigger; final regimen choice still goes to MDT (CHARTER §8.3).

Used By

Algorithms

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