Adult T-cell leukemia/lymphoma (ATLL) with paraneoplastic hypercalcemia (corrected calciu...

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

ID	`RF-ATLL-HYPERCALCEMIA`
Type	Red flag
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	`DIS-ATLL`
Sources	`SRC-ESMO-PTCL-2024` `SRC-IMC-HTLV-2017`

Red Flag Origin

Definition	Adult T-cell leukemia/lymphoma (ATLL) with paraneoplastic hypercalcemia (corrected calcium ≥11 mg/dL): present in ~50-70% of acute-type ATLL at diagnosis, driven by HTLV-1-induced PTHrP and RANKL expression
Clinical direction	hold
Category	organ-dysfunction
Shifts algorithm	ALGO-ATLL-1L

Trigger Logic

{
  "any_of": [
    {
      "comparator": ">=",
      "finding": "calcium_corrected_mg_dl",
      "threshold": 11
    },
    {
      "finding": "hypercalcemia_symptomatic",
      "value": true
    }
  ],
  "type": "composite"
}

Notes

Hypercalcemia is the second-most-common ATLL emergency presentation after lymphocytosis; per IMC-HTLV-2017 (Tsukasaki/IACR consensus) + ESMO-PTCL 2024 ATLL section: aggressive IV hydration, zoledronic acid, calcitonin; cytoreduction with EPOCH-based regimen + zidovudine/ interferon (acute) or watchful-wait → AZT/IFN (chronic/smoldering). Direction HOLD on routine induction until calcium <12 mg/dL and AKI resolved; priority 12. STUB — requires clinical co-lead signoff.

Used By

No reverse references found in the YAML corpus.