HGBL double-/triple-hit lymphoma — biology alone meets CNS-prophylaxis indication indepen...

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

ID	`RF-HGBL-DH-CNS-PROPHYLAXIS-TRIGGER`
Type	Red flag
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	`DIS-HGBL-DH`
Sources	`SRC-ESMO-DLBCL-2024` `SRC-NCCN-BCELL-2025`

Red Flag Origin

Definition	HGBL double-/triple-hit lymphoma — biology alone meets CNS-prophylaxis indication independent of CNS-IPI; mandates HD-MTX intercalation or IT MTX
Clinical direction	investigate
Category	high-risk-biology

Trigger Logic

{
  "any_of": [
    {
      "finding": "myc_rearranged",
      "value": true
    },
    {
      "finding": "double_hit_lymphoma",
      "value": true
    },
    {
      "finding": "triple_hit_lymphoma",
      "value": true
    }
  ],
  "type": "composite"
}

Notes

Per NCCN B-cell v.X.2025 HGBL section: CNS prophylaxis recommended for all HGBL-DH/TH regardless of CNS-IPI score (biology-driven); typical approach HD-MTX 3-3.5 g/m² IV intercalated with DA-EPOCH-R cycles. Direction INVESTIGATE because RF doesn't shift main regimen — adds CNS-directed therapy as plan particularity. shifts_algorithm:[] per REDFLAG_AUTHORING_GUIDE §4 rule 2. STUB — requires clinical co-lead signoff.

Used By

No reverse references found in the YAML corpus.