DLBCL with International Prognostic Index 4-5 (high risk) — supports Pola-R-CHP intensifi...

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

ID	`RF-IPI-HIGH`
Type	Red flag
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	`DIS-DLBCL-NOS`
Sources	`SRC-ESMO-DLBCL-2024` `SRC-NCCN-BCELL-2025`

Red Flag Origin

Definition	DLBCL with International Prognostic Index 4-5 (high risk) — supports Pola-R-CHP intensification per POLARIX and triggers CNS-prophylaxis discussion via CNS-IPI
Clinical direction	intensify
Category	risk-score

Trigger Logic

{
  "any_of": [
    {
      "comparator": ">=",
      "finding": "ipi_score",
      "threshold": 4
    },
    {
      "finding": "ipi_risk_group",
      "value": "high"
    },
    {
      "finding": "ipi_risk_group",
      "value": "high_intermediate"
    }
  ],
  "type": "composite_score"
}

Notes

IPI 4-5 in newly-diagnosed DLBCL gives 5-yr OS ~50% on R-CHOP-21 × 6; POLARIX showed clearest absolute benefit for Pola-R-CHP in this stratum. CNS-IPI 4-6 (which overlaps strongly with IPI 4-5) further triggers IT-MTX or HD-MTX prophylaxis per NCCN B-Cell 2025. Co-fires with RF-DLBCL-HIGH-IPI (which is the existing wired flag); kept distinct so the score-stratum cohort is recognizable in fixtures and so a cross-algorithm rule could later reference IPI 4-5 specifically (e.g., aggressive consolidation).

Used By

Algorithms

ALGO-DLBCL-1L - ALGO-DLBCL-1L