Histologic evidence of transformation to aggressive large B-cell lymphoma (DLBCL) on biop...

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

ID	`RF-AGGRESSIVE-HISTOLOGY-TRANSFORMATION`
Type	Red flag
Status	reviewed 2026-04-24 \| pending_clinical_signoff
Diseases	`DIS-HCV-MZL`
Sources	`SRC-ESMO-MZL-2024` `SRC-NCCN-BCELL-2025`

Red Flag Origin

Definition	Histologic evidence of transformation to aggressive large B-cell lymphoma (DLBCL) on biopsy or suspected by rapid clinical progression / LDH elevation / PET hotspot
Clinical direction	intensify
Category	transformation-progression
Shifts algorithm	ALGO-HCV-MZL-1L

Trigger Logic

{
  "any_of": [
    {
      "finding": "biopsy_shows_dlbcl",
      "value": true
    },
    {
      "all_of": [
        {
          "comparator": ">",
          "finding": "ldh_ratio_to_uln",
          "threshold": 1.5
        },
        {
          "comparator": "<",
          "finding": "clinical_progression_weeks",
          "threshold": 12
        }
      ]
    }
  ],
  "type": "symptom_composite"
}

Notes

Transformation shifts MZL from indolent to aggressive lymphoma treatment paradigm.

Used By

Algorithms

ALGO-HCV-MZL-1L - ALGO-HCV-MZL-1L
ALGO-HCV-MZL-2L - ALGO-HCV-MZL-2L
ALGO-NLPBL-2L - ALGO-NLPBL-2L
ALGO-NMZL-2L - ALGO-NMZL-2L
ALGO-SMZL-2L - ALGO-SMZL-2L

Indications

IND-HCV-MZL-1L-ANTIVIRAL - IND-HCV-MZL-1L-ANTIVIRAL
IND-HCV-MZL-POST-DAA-SURVEILLANCE - IND-HCV-MZL-POST-DAA-SURVEILLANCE
IND-NMZL-2L-BR - IND-NMZL-2L-BR
IND-PMBCL-2L-RICE-AUTOSCT - IND-PMBCL-2L-RICE-AUTOSCT
IND-SMZL-2L-BR - IND-SMZL-2L-BR

Questionnaires

QUEST-HCV-MZL-1L - HCV-associated Marginal Zone Lymphoma — first line