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Follicular lymphoma with clinical features concerning for transformation to aggressive ly...

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

IDRF-FL-TRANSFORMATION-SUSPECT
TypeRed flag
Statusreviewed 2026-04-25 | pending_clinical_signoff
DiseasesDIS-FL
SourcesSRC-ESMO-FL-2024 SRC-NCCN-BCELL-2025

Red Flag Origin

DefinitionFollicular lymphoma with clinical features concerning for transformation to aggressive lymphoma (typically DLBCL): rapid disease progression, isolated rapidly-growing nodal mass, sudden LDH rise, new B-symptoms, hypercalcemia, extranodal involvement onset
Clinical directionintensify
Categorytransformation-progression
Shifts algorithmALGO-FL-1L

Trigger Logic

{
  "any_of": [
    {
      "finding": "fl_transformation_suspect",
      "value": true
    },
    {
      "finding": "rapid_progression",
      "value": true
    },
    {
      "finding": "ldh_doubled_in_weeks",
      "value": true
    },
    {
      "finding": "biopsy_shows_dlbcl",
      "value": true
    },
    {
      "finding": "fl_grade_3b",
      "value": true
    }
  ],
  "type": "composite_clinical"
}

Notes

When suspected, urgent re-biopsy of the dominant lesion (PET-avid / rapidly-growing) is mandatory — true transformation is histologically DLBCL and treated with R-CHOP regardless of original FL diagnosis. FL grade 3B is biologically aggressive ab initio and treated as DLBCL from start. Without re-biopsy confirmation, transformation suspect alone shifts algorithm toward R-CHOP.

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