Active or latent infection requiring resolution / prophylaxis before initiating any anti-...

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

ID	`RF-FL-INFECTION-SCREENING`
Type	Red flag
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	`DIS-FL`
Sources	`SRC-ESMO-FL-2024` `SRC-NCCN-BCELL-2025`

Red Flag Origin

Definition	Active or latent infection requiring resolution / prophylaxis before initiating any anti-CD20-containing FL regimen (R-CHOP, BR, G-B, R-Lenalidomide, R-mono): HBsAg-positive (HBV reactivation risk), anti-HBc-positive (occult HBV — particular concern with bendamustine / obinutuzumab combinations), HCV-RNA-positive, HIV-positive, or active TB.
Clinical direction	hold
Category	infection-screening

Trigger Logic

{
  "any_of": [
    {
      "finding": "hbsag",
      "value": "positive"
    },
    {
      "finding": "anti_hbc_total",
      "value": "positive"
    },
    {
      "finding": "hcv_rna",
      "value": "positive"
    },
    {
      "finding": "hiv_status",
      "value": "positive"
    },
    {
      "finding": "active_tb",
      "value": true
    }
  ],
  "type": "lab_value"
}

Notes

HBsAg+ → mandatory entecavir/tenofovir prophylaxis from –7d through +12mo post-last anti-CD20 (longer for obinutuzumab — +18 mo). anti-HBc+ HBsAg-negative ("occult HBV") with bendamustine: HBV reactivation rates up to 20% reported — prophylaxis or close monitoring with HBV-DNA q3mo. HCV+: defer DAA cure pre-treatment if disease tempo allows; coordinate hepatology. Bendamustine reactivates HSV and VZV — acyclovir prophylaxis routine. PJP prophylaxis on G-bendamustine (T-cell depletion). FL is indolent — virtually always time to complete infectious workup before treating.

Used By

No reverse references found in the YAML corpus.