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Relapsed/refractory DLBCL post ≥2 prior systemic therapies, NOT a candidate for anti-CD19...

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

IDRF-DLBCL-CART-INELIGIBLE-POST-2L
TypeRed flag
Statusreviewed 2026-05-01 | pending_clinical_signoff
DiseasesDIS-DLBCL-NOS
SourcesSRC-ESMO-DLBCL-2024 SRC-NCCN-BCELL-2025

Red Flag Origin

DefinitionRelapsed/refractory DLBCL post ≥2 prior systemic therapies, NOT a candidate for anti-CD19 CAR-T (axi-cel / liso-cel / tisa-cel) due to frailty, organ dysfunction, comorbidity burden, manufacturing-window risk, prior CAR-T failure, or absent funded referral pathway. Routes 3L+ to loncastuximab tesirine (LOTIS-2 Caimi 2021 Lancet Oncol; ORR 48%, CR 24%, mPFS 4.9 mo, mOS 9.5 mo) — off-the-shelf outpatient ADC ideally suited for non-CAR-T-eligible frail patient. Distinct from universal RF-CAR-T-INELIGIBLE-AGE-COMORBID (which gates on age ≥75 + Charlson ≥4) — this flag covers the broader DLBCL-specific ineligibility composite including UA access constraints (no funded international referral pathway).
Clinical directionintensify
Categoryprior-therapy-class
Shifts algorithmALGO-DLBCL-2L

Trigger Logic

{
  "all_of": [
    {
      "any_of": [
        {
          "comparator": ">=",
          "finding": "prior_lines_count",
          "threshold": 2
        },
        {
          "finding": "post_pola_failure",
          "value": true
        },
        {
          "finding": "primary_refractory",
          "value": true
        }
      ]
    },
    {
      "any_of": [
        {
          "finding": "cart_ineligibility_reason"
        },
        {
          "finding": "cart_ineligible",
          "value": true
        },
        {
          "all_of": [
            {
              "comparator": ">=",
              "finding": "ecog",
              "threshold": 2
            },
            {
              "comparator": ">=",
              "finding": "age",
              "threshold": 70
            }
          ]
        },
        {
          "red_flag": "RF-CAR-T-INELIGIBLE-AGE-COMORBID"
        },
        {
          "red_flag": "RF-CAR-T-INELIGIBLE-ORGAN"
        }
      ]
    }
  ],
  "type": "composite_score"
}

Notes

Truthy lookup of `cart_ineligibility_reason` — if patient JSON sets this field to ANY explanatory string, the trigger fires. Provides flexibility for clinicians documenting case-specific rationale (e.g., "frailty_age_71_ECOG_2_no_international_referral_pathway", "prior_axicel_failure", "manufacturing_window_too_short_for_pd_kinetics"). Alternative composite path: explicit ECOG ≥2 + age ≥70 (frail older cohort) as observed in LOTIS-2 enrollment criteria. Universal CAR-T-ineligible RFs (age ≥75 + Charlson ≥4 OR organ dysfunction) are folded in via red_flag refs — this composite RF is the broader DLBCL-specific ineligibility signal.

Used By

Algorithms

Indications

Red flag