Active or latent infection requiring resolution / prophylaxis before initiating DA-EPOCH-...

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

ID	`RF-BURKITT-INFECTION-SCREENING`
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	Active or latent infection requiring resolution / prophylaxis before initiating DA-EPOCH-R or CODOX-M/IVAC in Burkitt: HBsAg-positive (mandatory anti-CD20 → high HBV reactivation risk), anti-HBc-positive (occult HBV), HCV-RNA-positive, HIV-positive (high prevalence in Burkitt — endemic and sporadic), or active TB. EBV testing recommended (endemic Burkitt EBV-driven; informs prognostication).
Clinical direction	hold
Category	infection-screening

Trigger Logic

{
  "any_of": [
    {
      "finding": "hbsag",
      "value": "positive"
    },
    {
      "finding": "anti_hbc_total",
      "value": "positive"
    },
    {
      "finding": "hcv_rna",
      "value": "positive"
    },
    {
      "finding": "hiv_status",
      "value": "positive"
    },
    {
      "finding": "active_tb",
      "value": true
    }
  ],
  "type": "lab_value"
}

Notes

HBsAg+ → entecavir or tenofovir prophylaxis from –7d through +12mo post-last anti-CD20 (rituximab in DA-EPOCH-R or CODOX-M/IVAC + R). HIV+ Burkitt: 25-40% of adult Burkitt is HIV-associated. Use full-dose DA-EPOCH-R per CALGB 50202 / Sparano subgroup — HIV-Burkitt outcomes approach HIV-negative when ART optimized. Active TB: full anti-TB course before chemoimmuno when feasible (Burkitt is so rapid that delays risk progression — MDT decision). PJP prophylaxis (TMP-SMX) during and 3-6 mo post-induction.

Used By

Algorithms

ALGO-BURKITT-1L - ALGO-BURKITT-1L
ALGO-BURKITT-2L - ALGO-BURKITT-2L