Stage III-IV / extranasal involvement / PINK-E score ≥3 — favor SMILE intensive regimen +...

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

ID	`RF-NK-T-NASAL-HIGH-RISK-BIOLOGY`
Type	Red flag
Status	reviewed 2026-04-25 \| pending_clinical_signoff
Diseases	`DIS-NK-T-NASAL`
Sources	`SRC-ESMO-PTCL-2024` `SRC-NCCN-BCELL-2025`

Red Flag Origin

Definition	Stage III-IV / extranasal involvement / PINK-E score ≥3 — favor SMILE intensive regimen + radiotherapy over reduced-intensity DDGP-mod/AspaMetDex.
Clinical direction	investigate
Category	high-risk-biology

Trigger Logic

{
  "any_of": [
    {
      "comparator": ">=",
      "finding": "ann_arbor_stage",
      "threshold": 3
    },
    {
      "comparator": ">=",
      "finding": "pink_e_score",
      "threshold": 3
    },
    {
      "finding": "extranasal_involvement",
      "value": true
    }
  ],
  "type": "composite_score"
}

Notes

PINK / PINK-E (Prognostic Index NK lymphoma) plus stage drives intensity selection. SMILE has CR rates >70% in advanced disease; less intensive regimens trail by 15-20%.

Used By

No reverse references found in the YAML corpus.