Active or latent infection requiring resolution / prophylaxis before initiating CLL thera...

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

ID	`RF-CLL-INFECTION-SCREENING`
Type	Red flag
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	`DIS-CLL`
Sources	`SRC-ESMO-CLL-2024` `SRC-NCCN-BCELL-2025`

Red Flag Origin

Definition	Active or latent infection requiring resolution / prophylaxis before initiating CLL therapy: HBsAg-positive (high HBV reactivation risk on obinutuzumab / rituximab + venetoclax), anti-HBc-positive (occult HBV), HCV-RNA-positive, HIV-positive, active TB, or hypogammaglobulinemia with recurrent infections (consider IVIG before BTKi/anti-CD20).
Clinical direction	hold
Category	infection-screening

Trigger Logic

{
  "any_of": [
    {
      "finding": "hbsag",
      "value": "positive"
    },
    {
      "finding": "anti_hbc_total",
      "value": "positive"
    },
    {
      "finding": "hcv_rna",
      "value": "positive"
    },
    {
      "finding": "hiv_status",
      "value": "positive"
    },
    {
      "finding": "active_tb",
      "value": true
    },
    {
      "all_of": [
        {
          "comparator": "<",
          "finding": "igg_g_l",
          "threshold": 4.0
        },
        {
          "finding": "recurrent_infections",
          "value": true
        }
      ]
    }
  ],
  "type": "lab_value"
}

Notes

Obinutuzumab (CLL14) is potent B-cell depleter — HBV reactivation risk among the highest of all CD20 antibodies. Mandatory entecavir / tenofovir prophylaxis from –7d through +12mo (some recommend +18-24mo given extended B-cell aplasia). HCV+: defer DAA cure pre-treatment if feasible; concurrent ledipasvir/sofosbuvir + venetoclax has CYP3A4 drug interactions — coordinate. Hypogamma + recurrent serious infection: IVIG 0.4 g/kg q3-4 weeks (per ESMO CLL §infection management). PJP prophylaxis routine on bendamustine, fludarabine, idelalisib; not routine on BTKi/V+O alone.

Used By

Indications

IND-CLL-3L-LISOCEL - IND-CLL-3L-LISOCEL