Frailty profile precluding intensive Burkitt regimens (CODOX-M/IVAC or DA-EPOCH-R full-do...

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

ID	`RF-BURKITT-FRAILTY-AGE`
Type	Red flag
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	`DIS-BURKITT`
Sources	`SRC-ESMO-BURKITT-2024` `SRC-NCCN-BCELL-2025`

Red Flag Origin

Definition	Frailty profile precluding intensive Burkitt regimens (CODOX-M/IVAC or DA-EPOCH-R full-dose): ECOG ≥3, OR (age ≥65 with G8 ≤14), OR composite frailty (age ≥70 + Charlson ≥3). Triggers de-escalation to attenuated R-mini-CHOP-like regimen or palliative R-CHOP — Burkitt curability dramatically lower in frail elderly.
Clinical direction	de-escalate
Category	frailty-age

Trigger Logic

{
  "any_of": [
    {
      "comparator": ">=",
      "finding": "ecog",
      "threshold": 3
    },
    {
      "all_of": [
        {
          "comparator": ">=",
          "finding": "age",
          "threshold": 65
        },
        {
          "comparator": "<=",
          "finding": "g8_score",
          "threshold": 14
        }
      ]
    },
    {
      "all_of": [
        {
          "comparator": ">=",
          "finding": "age",
          "threshold": 70
        },
        {
          "comparator": ">=",
          "finding": "charlson_score",
          "threshold": 3
        }
      ]
    }
  ],
  "type": "composite_score"
}

Notes

Burkitt is curable but cure rates collapse from 80-90% (young fit) to 20-40% (>65 frail) on full-intensity regimens — toxicity-driven treatment-related mortality is the dominant driver. NCCN B-Cell recommends DA-EPOCH-R (preferred over CODOX-M/IVAC) for fit elderly and modified DA-EPOCH-R or R-CHOP-like for frail. TLS prophylaxis mandatory regardless of dose intensity (rasburicase preferred over allopurinol given high TLS risk in Burkitt).

Used By

Algorithms

ALGO-BURKITT-2L - ALGO-BURKITT-2L