Burkitt primary-refractory (no CR after 2 cycles induction) OR early relapse <6 months po...

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

ID	`RF-BURKITT-TRANSFORMATION-PROGRESSION`
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	Burkitt primary-refractory (no CR after 2 cycles induction) OR early relapse <6 months post-induction OR rapidly progressive disease during pre-phase corticosteroids — extremely poor prognosis subset; routes to intensive salvage (R-ICE, R-IVAC) with auto/alloSCT bridge intent or CD19 CAR-T trial enrollment.
Clinical direction	intensify
Category	transformation-progression

Trigger Logic

{
  "any_of": [
    {
      "finding": "burkitt_primary_refractory",
      "value": true
    },
    {
      "finding": "burkitt_early_relapse_lt_6mo",
      "value": true
    },
    {
      "finding": "rapid_progression",
      "value": true
    },
    {
      "finding": "ldh_doubled_in_weeks",
      "value": true
    }
  ],
  "type": "composite_clinical"
}

Notes

Burkitt that fails 1L (DA-EPOCH-R or CODOX-M/IVAC) has dismal salvage prognosis: 2-year OS <20% in r/r adult Burkitt across registry data. R-ICE / R-IVAC + alloSCT (preferred over autoSCT given rapid relapses) is the standard backbone; CD19 CAR-T (axi-cel, tisa-cel) on trial / off-label use increasingly evidenced. Avoid delaying — rapid disease doubling time (~24h proliferation) means re-staging windows are days, not weeks. MDT escalation mandatory.

Used By

Algorithms

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