Failure to achieve CR after 2 courses cladribine OR early relapse (<2 years) — switch to...

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

ID	`RF-HCL-TRANSFORMATION-PROGRESSION`
Type	Red flag
Status	reviewed 2026-04-25 \| pending_clinical_signoff
Diseases	`DIS-HCL`
Sources	`SRC-ESMO-DLBCL-2024` `SRC-NCCN-BCELL-2025`

Red Flag Origin

Definition	Failure to achieve CR after 2 courses cladribine OR early relapse (<2 years) — switch to alternative purine analog + rituximab, vemurafenib (BRAF V600E+), or moxetumomab pasudotox.
Clinical direction	investigate
Category	transformation-progression

Trigger Logic

{
  "any_of": [
    {
      "finding": "hcl_no_cr_after_cladribine",
      "value": true
    },
    {
      "finding": "hcl_early_relapse_under_2y",
      "value": true
    }
  ],
  "type": "composite_clinical"
}

Notes

Refractory/early-relapsed HCL has multiple 2L options; selection driven by BRAF status and prior exposure. Sits in 2L Algorithm not 1L.

Used By

Algorithms

ALGO-HCL-2L - ALGO-HCL-2L