High-grade B-cell lymphoma double-/triple-hit with active or imminent TLS at diagnosis: L...

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

ID	`RF-HGBL-DH-EMERGENCY-TLS`
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	High-grade B-cell lymphoma double-/triple-hit with active or imminent TLS at diagnosis: LDH >2× ULN, uric acid >7.5 mg/dL, hyperkalemia, hyperphosphatemia, hypocalcemia, AKI
Clinical direction	hold
Category	organ-dysfunction
Shifts algorithm	ALGO-HGBL-DH-1L

Trigger Logic

{
  "any_of": [
    {
      "comparator": ">",
      "finding": "ldh_ulnratio",
      "threshold": 2
    },
    {
      "comparator": ">",
      "finding": "uric_acid_mg_dl",
      "threshold": 7.5
    },
    {
      "comparator": ">",
      "finding": "potassium_mmol_l",
      "threshold": 5.5
    },
    {
      "comparator": ">",
      "finding": "phosphate_mg_dl",
      "threshold": 4.5
    },
    {
      "finding": "tls_active",
      "value": true
    }
  ],
  "type": "composite"
}

Notes

HGBL-DH (MYC + BCL2 ± BCL6 rearrangement) behaves biologically like Burkitt — high proliferation index, strong TLS predisposition. Per NCCN B-cell v.X.2025 HGBL section: DA-EPOCH-R is preferred 1L; rasburicase pre-cycle-1 + IV hydration mandatory. Direction HOLD until stabilized; priority 10. STUB — requires clinical co-lead signoff.

Used By

No reverse references found in the YAML corpus.