DLBCL with high CNS-IPI risk (CNS-IPI ≥4) OR specific anatomic sites (testicular, breast,...

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

ID	`RF-DLBCL-CNS-RISK`
Type	Red flag
Status	reviewed 2026-04-25 \| pending_clinical_signoff
Diseases	`DIS-DLBCL-NOS`
Sources	`SRC-ESMO-DLBCL-2024` `SRC-NCCN-BCELL-2025`

Red Flag Origin

Definition	DLBCL with high CNS-IPI risk (CNS-IPI ≥4) OR specific anatomic sites (testicular, breast, kidney/adrenal, paranasal sinus, bone marrow with high-risk pathology) — triggers CNS prophylaxis pathway
Clinical direction	investigate
Category	high-risk-biology

Trigger Logic

{
  "any_of": [
    {
      "comparator": ">=",
      "finding": "cns_ipi_score",
      "threshold": 4
    },
    {
      "finding": "anatomic_cns_risk_site",
      "value": true
    },
    {
      "finding": "testicular_involvement",
      "value": true
    }
  ],
  "type": "composite_score"
}

Notes

CNS-IPI: age >60, LDH >ULN, ECOG ≥2, stage III/IV, ≥2 extranodal sites, kidney/adrenal involvement (each 1 point; max 6). Score ≥4 = ~12% CNS relapse risk. Anatomic high-risk sites independently warrant prophylaxis regardless of score. Standard prophylaxis: high-dose methotrexate (3-3.5 g/m² IV) intercalated with R-CHOP cycles, OR intrathecal MTX (less preferred — modest efficacy). Direction "investigate" — does not shift main regimen, but mandates additional CNS-directed therapy as particularity in the Plan.

DLBCL with high CNS-IPI risk (CNS-IPI ≥4) OR specific anatomic sites (testicular, breast,...

Red Flag Origin

Trigger Logic

Notes

Used By

Algorithms

Indications