Philadelphia-positive B-ALL (BCR-ABL1+) — TKI (imatinib/dasatinib/ponatinib) + chemothera...

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

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

Red Flag Origin

Definition	Philadelphia-positive B-ALL (BCR-ABL1+) — TKI (imatinib/dasatinib/ponatinib) + chemotherapy is standard; Ph-like B-ALL signature requires JAK/ABL pathway-targeted addition.
Clinical direction	intensify
Category	high-risk-biology
Shifts algorithm	ALGO-B-ALL-1L

Trigger Logic

{
  "any_of": [
    {
      "finding": "ph_positive",
      "value": true
    },
    {
      "finding": "bcr_abl1",
      "value": "positive"
    },
    {
      "finding": "ph_like_signature",
      "value": true
    }
  ],
  "type": "biomarker"
}

Notes

Ph+ B-ALL is a fundamentally different disease — TKI addition reverses what was historically the worst-prognosis subgroup. NCCN/ESMO both place TKI testing in upfront workup mandate.

Used By

Algorithms

ALGO-B-ALL-1L - ALGO-B-ALL-1L
ALGO-B-ALL-2L - ALGO-B-ALL-2L

Indications

IND-B-ALL-2L-INOTUZUMAB - IND-B-ALL-2L-INOTUZUMAB
IND-B-ALL-3L-TISAGENLECLEUCEL - IND-B-ALL-3L-TISAGENLECLEUCEL
IND-B-ALL-BLINATUMOMAB-MRD-OR-RR - IND-B-ALL-BLINATUMOMAB-MRD-OR-RR
IND-B-ALL-POST-CONSOLIDATION-POMP-MAINTENANCE - IND-B-ALL-POST-CONSOLIDATION-POMP-MAINTENANCE