Baseline organ dysfunction precluding standard R-CHOP doses: LVEF <50% (anthracycline con...

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

ID	`RF-DLBCL-ORGAN-DYSFUNCTION`
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	Baseline organ dysfunction precluding standard R-CHOP doses: LVEF <50% (anthracycline contraindicated), CrCl <30 mL/min (severe cyclophosphamide / methotrexate dose constraints), bilirubin >3× ULN (vincristine / doxorubicin metabolism), or DLCO <60% (lung-toxicity risk on CHOP-based therapy).
Clinical direction	de-escalate
Category	organ-dysfunction
Shifts algorithm	ALGO-DLBCL-1L

Trigger Logic

{
  "any_of": [
    {
      "comparator": "<",
      "finding": "lvef_percent",
      "threshold": 50
    },
    {
      "comparator": "<",
      "finding": "creatinine_clearance_ml_min",
      "threshold": 30
    },
    {
      "comparator": ">=",
      "finding": "bilirubin_ratio_to_uln",
      "threshold": 3
    },
    {
      "comparator": "<",
      "finding": "dlco_percent",
      "threshold": 60
    }
  ],
  "type": "lab_value"
}

Notes

LVEF <50%: substitute liposomal doxorubicin or omit anthracycline (R-CEOP using etoposide; or R-GCVP). CrCl <30: cyclophosphamide reduce 25-50% per institutional renal-dosing protocol; HD-MTX contraindicated for CNS prophylaxis (use IT only). DLCO <60%: document baseline carefully; pulmonary toxicity is uncommon at standard CHOP cycles but accumulates at salvage. This RF de-escalates toward R-CHOP standard from Pola-R-CHP intensification when both fire (high IPI + organ dysfunction common in elderly).

Used By

Algorithms

ALGO-DLBCL-1L - ALGO-DLBCL-1L
ALGO-DLBCL-2L - ALGO-DLBCL-2L