B-ALL with CNS-2 (CSF blasts, WBC <5/µL) or CNS-3 (CSF WBC ≥5/µL with blasts, or cranial...

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

ID	`RF-B-ALL-CNS-LEUKEMIA`
Type	Red flag
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	`DIS-B-ALL`
Sources	`SRC-BLAST-GOKBUGET-2018` `SRC-CALGB-10403-STOCK-2019` `SRC-NCCN-BCELL-2025`

Red Flag Origin

Definition	B-ALL with CNS-2 (CSF blasts, WBC <5/µL) or CNS-3 (CSF WBC ≥5/µL with blasts, or cranial nerve palsy) status at diagnosis or relapse — mandates intensified IT therapy ± cranial RT
Clinical direction	intensify
Category	high-risk-biology

Trigger Logic

{
  "any_of": [
    {
      "finding": "csf_blasts_present",
      "value": true
    },
    {
      "comparator": ">=",
      "finding": "csf_wbc_per_ul",
      "threshold": 5
    },
    {
      "finding": "cranial_nerve_palsy",
      "value": true
    },
    {
      "finding": "cns_parenchymal_mass",
      "value": true
    },
    {
      "finding": "cns_status",
      "value": "CNS-3"
    }
  ],
  "type": "composite"
}

Notes

Per NCCN ALL/LBL: CNS-3 at diagnosis warrants cranial RT (12-18 Gy) addition + intensified IT MTX/Ara-C/HC schedule. CALGB-10403 + GMALL protocols both define CNS-2/CNS-3 thresholds and IT escalation. Direction INTENSIFY — adds CNS-directed therapy to chosen 1L regimen; priority 20. STUB — requires clinical co-lead signoff.

Used By

No reverse references found in the YAML corpus.