Refractory or progressive DLBCL after ≥1 line of standard immunochemotherapy: primary ref...

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

ID	`RF-DLBCL-TRANSFORMATION-PROGRESSION`
Type	Red flag
Status	reviewed 2026-04-26 \| pending_clinical_signoff
Diseases	`DIS-DLBCL-NOS`
Sources	`SRC-ESMO-DLBCL-2024` `SRC-NCCN-BCELL-2025`

Red Flag Origin

Definition	Refractory or progressive DLBCL after ≥1 line of standard immunochemotherapy: primary refractory disease (no CR/PR after 4 cycles of R-CHOP or equivalent), early relapse (<12 months from end of 1L), or transformation to a more aggressive histology (HGBL-DH/TH or Burkitt-like on re-biopsy at relapse). Routes patient out of standard 1L Indications and into 2L+ algorithms (CAR-T eligibility assessment, salvage chemotherapy ± autoSCT, bispecific antibodies, polatuzumab-bendamustine- rituximab regimens).
Clinical direction	intensify
Category	transformation-progression
Shifts algorithm	ALGO-DLBCL-2L

Trigger Logic

{
  "any_of": [
    {
      "finding": "primary_refractory_dlbcl",
      "value": true
    },
    {
      "finding": "early_relapse_under_12mo",
      "value": true
    },
    {
      "finding": "transformation_to_hgbl_or_burkitt",
      "value": true
    },
    {
      "all_of": [
        {
          "finding": "post_4_cycle_response",
          "value": "stable_or_progressive"
        },
        {
          "comparator": ">=",
          "finding": "line_of_therapy",
          "threshold": 1
        }
      ]
    }
  ],
  "type": "composite_score"
}

Notes

Closes the 5-type matrix gap for DLBCL-NOS (REDFLAG_AUTHORING_GUIDE §2 — every disease should have a transformation-progression entry). The clinical concept differs from indolent-lymphoma transformation (FL → DLBCL or CLL → DLBCL Richter): DLBCL is already aggressive at baseline, so "transformation" here means either (a) response failure to first-line standard regimens, or (b) histologic re-classification to an even more aggressive entity (HGBL with MYC + BCL2/BCL6 rearrangements, or Burkitt-like) on re-biopsy at relapse. Operationally drives: - CAR-T eligibility assessment (axi-cel / liso-cel / tisagenlecleucel per FDA/EMA labels for r/r DLBCL ≥2L; ZUMA-7 / TRANSFORM / BELINDA support 2L use in early-relapse / refractory disease) - Salvage chemo (R-DHAP / R-ICE) + autoSCT for chemo-sensitive relapse > 12 months - Bispecific antibodies (epcoritamab, glofitamab) in CAR-T-ineligible or post-CAR-T relapse - Pola-BR for transplant-ineligible or post-CAR-T STUB — content reflects standard 2026 practice; clinical reviewer must confirm the trigger thresholds (especially the "primary refractory" definition, which varies between SCHOLAR-1 and FDA-label conventions) before this RedFlag is w...

Used By

No reverse references found in the YAML corpus.