Baseline organ dysfunction precluding standard FL regimens (BR / R-CHOP / R-Lenalidomide...

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

ID	`RF-FL-ORGAN-DYSFUNCTION`
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	Baseline organ dysfunction precluding standard FL regimens (BR / R-CHOP / R-Lenalidomide / G-bendamustine): LVEF <50% (anthracycline contraindicated in R-CHOP), CrCl <30 (cyclophosphamide / lenalidomide dose-modify), bilirubin >3× ULN (vincristine / doxorubicin metabolism), or significant pulmonary disease (DLCO <60% — bendamustine pneumonitis rare but reported).
Clinical direction	de-escalate
Category	organ-dysfunction

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%: avoid R-CHOP; use BR or R-mono (rituximab single-agent — excellent option in low-burden / unfit indolent FL). CrCl <30: lenalidomide dose-reduce per renal-dosing table (10 mg q.d. if CrCl 30-60; 15 mg q.o.d. if CrCl <30); cyclophosphamide reduce 25-50%. Bendamustine has rare but real pulmonary toxicity (~1% pneumonitis) and reactivates HBV / HSV / VZV — pre-screening mandatory. CD20 antibody alone is highly active in low-tumor-burden FL (RESORT, PRIMA placebo arm) — frequent first-line option for organ-compromised.

Used By

No reverse references found in the YAML corpus.