Hypercalcemia (Ca >12 mg/dL) at diagnosis — hallmark of aggressive ATLL; requires bisphos...

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

ID	`RF-ATLL-ORGAN-DYSFUNCTION`
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	Hypercalcemia (Ca >12 mg/dL) at diagnosis — hallmark of aggressive ATLL; requires bisphosphonate/calcitonin urgently and predicts aggressive subtype regardless of WBC.
Clinical direction	intensify
Category	organ-dysfunction
Shifts algorithm	ALGO-ATLL-1L

Trigger Logic

{
  "any_of": [
    {
      "comparator": ">",
      "finding": "calcium_mg_dl",
      "threshold": 12
    },
    {
      "finding": "atll_hypercalcemia",
      "value": true
    }
  ],
  "type": "lab_value"
}

Notes

Hypercalcemia in ATLL is paraneoplastic (RANKL-driven by HTLV-1+ T cells) — its presence overrides Shimoyama subtyping toward aggressive variant; AZT+IFN-α inadequate. Immediate hypercalcemia management + aggressive chemo (mLSG-15 / EPOCH-like) standard.

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...