DLBCL with International Prognostic Index ≥2 — selects intensified Pola-R-CHP over R-CHOP...

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

ID	`RF-DLBCL-HIGH-IPI`
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 International Prognostic Index ≥2 — selects intensified Pola-R-CHP over R-CHOP per POLARIX evidence
Clinical direction	intensify
Category	risk-score
Shifts algorithm	ALGO-DLBCL-1L

Trigger Logic

{
  "any_of": [
    {
      "comparator": ">=",
      "finding": "ipi_score",
      "threshold": 2
    },
    {
      "finding": "high_ipi",
      "value": true
    }
  ],
  "type": "composite_score"
}

Notes

Per POLARIX trial: in IPI ≥2 newly-diagnosed DLBCL, Pola-R-CHP showed superior PFS (~6.5% absolute at 2 years) vs R-CHOP. Toxicity profile comparable except higher peripheral neuropathy with polatuzumab. Major access constraint in Ukraine — polatuzumab not НСЗУ-reimbursed; flag funding pathway in Plan.

Used By

Algorithms

ALGO-DLBCL-1L - ALGO-DLBCL-1L

Indications

IND-DLBCL-1L-POLA-R-CHP - IND-DLBCL-1L-POLA-R-CHP
IND-DLBCL-1L-RCHOP - IND-DLBCL-1L-RCHOP
IND-DLBCL-1L-RCHOP-ISRT-EARLY - IND-DLBCL-1L-RCHOP-ISRT-EARLY
IND-DLBCL-RENAL-FAILURE-MOD-RCHOP - IND-DLBCL-RENAL-FAILURE-MOD-RCHOP

Red flag

RF-IPI-HIGH - DLBCL with International Prognostic Index 4-5 (high risk) — supports Pola-R-CHP intensifi...
RF-IPI-INTERMEDIATE - DLBCL with International Prognostic Index 2-3 (intermediate risk) — opens MDT discussion...
RF-IPI-LOW - DLBCL with International Prognostic Index 0-1 (low risk) — supports R-CHOP standard backb...