Baseline organ dysfunction precluding standard CHOP/CHP-Bv doses in ALCL: LVEF <50% (anth...

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

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

Red Flag Origin

Definition	Baseline organ dysfunction precluding standard CHOP/CHP-Bv doses in ALCL: LVEF <50% (anthracycline / brentuximab cardiotoxicity overlap), CrCl <30 (cyclophosphamide dose constraints), bilirubin >3× ULN (vincristine / brentuximab metabolism — brentuximab dose-modify Child-Pugh B; avoid C), or pre-existing peripheral neuropathy ≥grade 2 (vincristine + brentuximab both neuropathic — combination prohibitive).
Clinical direction	de-escalate
Category	organ-dysfunction

Trigger Logic

{
  "any_of": [
    {
      "comparator": "<",
      "finding": "lvef_percent",
      "threshold": 50
    },
    {
      "comparator": "<",
      "finding": "creatinine_clearance_ml_min",
      "threshold": 30
    },
    {
      "comparator": ">=",
      "finding": "bilirubin_ratio_to_uln",
      "threshold": 3
    },
    {
      "finding": "child_pugh_class",
      "value": "C"
    },
    {
      "comparator": ">=",
      "finding": "peripheral_neuropathy_grade",
      "threshold": 2
    }
  ],
  "type": "lab_value"
}

Notes

ALCL is overwhelmingly CD30+, so CHP-Bv (ECHELON-2) is the standard backbone — but brentuximab adds neuropathy on top of vincristine. With baseline neuropathy ≥2, omit vincristine (CHP without V) or substitute gemcitabine-based salvage. LVEF <50%: substitute liposomal doxorubicin or omit anthracycline (GEM-P). Severe hepatic dysfunction: brentuximab contraindicated in Child-Pugh C.

Used By

No reverse references found in the YAML corpus.