Classical Hodgkin lymphoma primary-refractory disease (positive interim PET2 with Deauvil...
Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.
| ID | RF-CHL-TRANSFORMATION-PROGRESSION |
|---|---|
| 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 | Classical Hodgkin lymphoma primary-refractory disease (positive interim PET2 with Deauville 4-5 or end-of-treatment PET-positive) OR early relapse <12 months post-ABVD/A+AVD — high-risk subset routes to salvage chemo (ICE / DHAP / BV-bendamustine) followed by autoSCT consolidation; consider BV-nivolumab combination for chemo-refractory. |
|---|---|
| Clinical direction | intensify |
| Category | transformation-progression |
Trigger Logic
{
"any_of": [
{
"finding": "chl_primary_refractory",
"value": true
},
{
"finding": "interim_pet_deauville_4_5",
"value": true
},
{
"finding": "chl_early_relapse_lt_12mo",
"value": true
},
{
"finding": "end_treatment_pet_positive",
"value": true
}
],
"type": "composite_clinical"
}
Notes
Interim-PET-adapted approach (RATHL / AHL2011): PET2 positive → intensify (BEACOPP-esc) or salvage workup; PET2 negative → omit bleomycin (AVD). Primary-refractory or <12mo relapse: salvage chemoimmuno (BV-bendamustine, BV-DHAP, ICE) with target ≥CR before autoSCT (CR rates higher with BV-containing salvage per Moskowitz). Post-autoSCT BV maintenance per AETHERA in high-risk (extranodal at relapse, primary-refractory, or <12mo CR1). For multiply-refractory: nivolumab + brentuximab combinations now preferred over single-agent CPI per CheckMate-744 / KEYNOTE-204.
Used By
Algorithms
ALGO-CHL-2L- ALGO-CHL-2L
Indications
IND-CHL-CHILD-PUGH-C-MOD- IND-CHL-CHILD-PUGH-C-MODIND-CHL-PREGNANCY-MOD-ABVD- IND-CHL-PREGNANCY-MOD-ABVD