Shimoyama acute or lymphoma subtype (LDH >2×ULN, BUN >ULN, albumin <ULN — any one) — aggr...

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

ID	`RF-ATLL-HIGH-RISK-BIOLOGY`
Type	Red flag
Status	reviewed 2026-04-25 \| pending_clinical_signoff
Diseases	`DIS-ATLL`
Sources	`SRC-ESMO-PTCL-2024` `SRC-NCCN-BCELL-2025`

Red Flag Origin

Definition	Shimoyama acute or lymphoma subtype (LDH >2×ULN, BUN >ULN, albumin <ULN — any one) — aggressive variant; AZT+IFN-α inadequate, requires intensive chemo (mLSG-15) ± alloSCT.
Clinical direction	intensify
Category	high-risk-biology
Shifts algorithm	ALGO-ATLL-1L

Trigger Logic

{
  "any_of": [
    {
      "finding": "shimoyama_aggressive_subtype",
      "value": true
    },
    {
      "comparator": ">",
      "finding": "ldh_x_uln",
      "threshold": 2
    },
    {
      "finding": "bun_above_uln",
      "value": true
    },
    {
      "finding": "albumin_below_uln",
      "value": true
    }
  ],
  "type": "composite_score"
}

Notes

Shimoyama's prognostic system is THE classifier in ATLL: smoldering/chronic-favorable get watch-and-wait or AZT+IFN-α; acute/lymphoma get aggressive chemo. Engine routes appropriately.

Used By

Algorithms

ALGO-ATLL-1L - ALGO-ATLL-1L

Red flag

RF-ATLL-SHIMOYAMA-INDOLENT - Shimoyama smoldering or chronic-favourable subtype of ATLL. Smoldering: ≥5% circulating a...