Baseline organ dysfunction precluding HD-MTX-containing CODOX-M/IVAC or full-dose DA-EPOC...

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

ID	`RF-BURKITT-ORGAN-DYSFUNCTION`
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	Baseline organ dysfunction precluding HD-MTX-containing CODOX-M/IVAC or full-dose DA-EPOCH-R in Burkitt lymphoma: CrCl <50 (HD-methotrexate contraindicated, Burkitt CNS-prophylaxis-mandatory disease), LVEF <50% (anthracycline contraindicated), bilirubin >3× ULN (vincristine / doxorubicin / methotrexate metabolism), or pulmonary DLCO <60%.
Clinical direction	de-escalate
Category	organ-dysfunction

Trigger Logic

{
  "any_of": [
    {
      "comparator": "<",
      "finding": "creatinine_clearance_ml_min",
      "threshold": 50
    },
    {
      "comparator": "<",
      "finding": "lvef_percent",
      "threshold": 50
    },
    {
      "comparator": ">=",
      "finding": "bilirubin_ratio_to_uln",
      "threshold": 3
    },
    {
      "comparator": "<",
      "finding": "dlco_percent",
      "threshold": 60
    }
  ],
  "type": "lab_value"
}

Notes

Burkitt is curable but CODOX-M/IVAC and HD-MTX require strict renal function (≥50 mL/min for HD-MTX systemic; ≥60 preferred). CrCl <50 → shift to DA-EPOCH-R (no HD-MTX systemic; IT MTX still feasible) per Roschewski et al. NEJM 2020 NCI 9177 trial. LVEF <50%: substitute liposomal doxorubicin in DA-EPOCH-R, or pursue lower-intensity R-CHOP + IT MTX in palliative intent. CNS prophylaxis is mandatory in Burkitt regardless of dose intensity — IT MTX/cytarabine 4-8 doses.

Used By

Algorithms

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

Red flag

RF-BURKITT-IFOS-CONTRAINDICATED - Ifosfamide contraindicated or high-risk in relapsed/refractory Burkitt lymphoma 2L salvag...