AITL patient frail or elderly unfit for full-dose CHOEP / CHP-Bv induction: ECOG ≥3, OR a...

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

ID	`RF-AITL-FRAILTY-AGE`
Type	Red flag
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	`DIS-AITL`
Sources	`SRC-ESMO-PTCL-2024` `SRC-NCCN-BCELL-2025`

Red Flag Origin

Definition	AITL patient frail or elderly unfit for full-dose CHOEP / CHP-Bv induction: ECOG ≥3, OR age ≥75, OR (age ≥70 + ≥2 comorbidities + albumin <3.5), OR explicit clinical assessment "unfit for intensive chemotherapy". AITL median age at diagnosis is 65-70 — most patients fall close to this threshold.
Clinical direction	de-escalate
Category	frailty-age

Trigger Logic

{
  "any_of": [
    {
      "comparator": ">=",
      "finding": "ecog",
      "threshold": 3
    },
    {
      "comparator": ">=",
      "finding": "age",
      "threshold": 75
    },
    {
      "finding": "fit_for_intensive_chemo",
      "value": false
    },
    {
      "all_of": [
        {
          "comparator": ">=",
          "finding": "age",
          "threshold": 70
        },
        {
          "comparator": ">=",
          "finding": "comorbidity_count",
          "threshold": 2
        },
        {
          "comparator": "<",
          "finding": "albumin_g_dl",
          "threshold": 3.5
        }
      ]
    }
  ],
  "type": "composite_score"
}

Notes

AITL is the second-most-common PTCL subtype and predominantly affects older adults (median 65-70). ECHELON-2 (brentuximab-CHP) included patients up to age 80 but post-hoc subgroups suggest tolerability concern >75. Frailty options: CHOP (drop etoposide), mini-CHOP (50-60% doses) per GELA LNH03-7B paradigm extrapolated from DLBCL, GEM-P (gemcitabine + methylprednisolone + cisplatin) as outpatient alternative, or romidepsin-monotherapy in unfit relapse. Geriatric assessment (G8 / CGA) prior to regimen selection. Direction "de-escalate" conflicts with HIGH-RISK-BIOLOGY "intensify" — engine surfaces conflict to MDT.

Used By

No reverse references found in the YAML corpus.