Baseline organ dysfunction precluding standard ABVD or A+AVD in classical Hodgkin lymphom...

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

ID	`RF-CHL-ORGAN-DYSFUNCTION`
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	Baseline organ dysfunction precluding standard ABVD or A+AVD in classical Hodgkin lymphoma: LVEF <50% (doxorubicin contraindicated), DLCO <60% (bleomycin pneumonitis risk — drives bleomycin omission or A+AVD substitution), CrCl <30 (cyclophosphamide constraint if BEACOPP), or baseline peripheral neuropathy ≥grade 2 (vincristine + brentuximab in A+AVD both neuropathic).
Clinical direction	de-escalate
Category	organ-dysfunction

Trigger Logic

{
  "any_of": [
    {
      "comparator": "<",
      "finding": "lvef_percent",
      "threshold": 50
    },
    {
      "comparator": "<",
      "finding": "dlco_percent",
      "threshold": 60
    },
    {
      "comparator": "<",
      "finding": "creatinine_clearance_ml_min",
      "threshold": 30
    },
    {
      "comparator": ">=",
      "finding": "peripheral_neuropathy_grade",
      "threshold": 2
    }
  ],
  "type": "lab_value"
}

Notes

DLCO <60%: omit bleomycin (AVD without B) or use A+AVD per ECHELON-1 (brentuximab substitutes for bleomycin — major reduction in pulmonary toxicity). LVEF <50%: substitute liposomal doxorubicin or use non-anthracycline (BV-ESHAP / GVD) — rare in chemo-naive cHL but relevant in older patients with baseline cardiomyopathy. Bleomycin pulmonary toxicity is dose-cumulative (>270 IU lifetime risky); baseline DLCO assessment mandatory and re-check between cycles 2-3.

Used By

No reverse references found in the YAML corpus.