Baseline organ dysfunction precluding standard PCV (procarbazine / CCNU / vincristine) or...

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

ID	`RF-GLIOMA-LOW-GRADE-ORGAN-DYSFUNCTION`
Type	Red flag
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	`DIS-GLIOMA-LOW-GRADE`
Sources	`SRC-ESMO-SARCOMA-2024` `SRC-NCCN-CNS-2025`

Red Flag Origin

Definition	Baseline organ dysfunction precluding standard PCV (procarbazine / CCNU / vincristine) or temozolomide adjuvant in low-grade glioma: CrCl <30 mL/min (CCNU / temozolomide dose adjustment), bilirubin >3× ULN (CCNU / vincristine hepatic clearance), severe cytopenias (ANC <1.5, platelets <100), or DLCO <60% (CCNU pulmonary fibrosis signal at cumulative doses).
Clinical direction	de-escalate
Category	organ-dysfunction

Trigger Logic

{
  "any_of": [
    {
      "comparator": "<",
      "finding": "creatinine_clearance_ml_min",
      "threshold": 30
    },
    {
      "comparator": ">=",
      "finding": "bilirubin_ratio_to_uln",
      "threshold": 3
    },
    {
      "comparator": "<",
      "finding": "anc_x10_9_per_l",
      "threshold": 1.5
    },
    {
      "comparator": "<",
      "finding": "platelets_x10_9_per_l",
      "threshold": 100
    },
    {
      "comparator": "<",
      "finding": "dlco_percent",
      "threshold": 60
    }
  ],
  "type": "lab_value"
}

Notes

RTOG 9802 established RT + PCV as standard for high-risk LGG; PCV is marrow-suppressive (cumulative thrombocytopenia from CCNU is a leading cause of treatment discontinuation). Temozolomide is better-tolerated alternative widely substituted in practice (CATNON, EORTC 22033 data in IDH-mut anaplastic gliomas) — also marrow-suppressive but more predictable. CrCl <30: temozolomide dose reduce 25%, CCNU contra- indicated. Cytopenias at baseline frequently reflect prior RT — defer systemic therapy until recovery. Vorasidenib (IDH-mut LGG, INDIGO trial) is now an option with more favorable toxicity profile — consider in organ-dysfunction setting if IDH-mut.

Used By

No reverse references found in the YAML corpus.