Frailty profile precluding full-dose ABVD or A+AVD in classical Hodgkin lymphoma: ECOG ≥3...

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

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

Red Flag Origin

Definition	Frailty profile precluding full-dose ABVD or A+AVD in classical Hodgkin lymphoma: ECOG ≥3, OR (age ≥60 with ≥2 comorbidities — elderly cHL has worse outcomes regardless of regimen), OR composite frailty (age ≥75 + Charlson ≥3 + albumin <3.5). Triggers de-escalation to AVD (omit bleomycin), VEPEMB (gem-vinorelbine-based), or BV-AVD.
Clinical direction	de-escalate
Category	frailty-age

Trigger Logic

{
  "any_of": [
    {
      "comparator": ">=",
      "finding": "ecog",
      "threshold": 3
    },
    {
      "all_of": [
        {
          "comparator": ">=",
          "finding": "age",
          "threshold": 60
        },
        {
          "comparator": ">=",
          "finding": "comorbidity_count",
          "threshold": 2
        }
      ]
    },
    {
      "all_of": [
        {
          "comparator": ">=",
          "finding": "age",
          "threshold": 75
        },
        {
          "comparator": ">=",
          "finding": "charlson_score",
          "threshold": 3
        },
        {
          "comparator": "<",
          "finding": "albumin_g_dl",
          "threshold": 3.5
        }
      ]
    }
  ],
  "type": "composite_score"
}

Notes

Elderly cHL (>60y) outcomes substantially worse — bleomycin pulmonary toxicity disproportionately high (>20% pneumonitis with BLEO in age ≥60 per German Hodgkin trials); omit bleomycin or use BV substitution (A+AVD per ECHELON-1 elderly subgroup — favorable PFS without bleo pneumonitis). Frail / unfit: VEPEMB or BV-bendamustine combinations (palliative-curative balance). BEACOPP-escalated contraindicated >60y due to TRM. CGA-guided dose adjustment essential.

Used By

Algorithms

ALGO-CHL-2L - ALGO-CHL-2L