Multiple relapses or histologic transformation to DLBCL/THRLBCL on rebiopsy — switch to a...

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

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

Red Flag Origin

Definition	Multiple relapses or histologic transformation to DLBCL/THRLBCL on rebiopsy — switch to aggressive B-cell pathway (R-CHOP-based ± autoSCT consideration).
Clinical direction	intensify
Category	transformation-progression

Trigger Logic

{
  "any_of": [
    {
      "finding": "nlpbl_multiple_relapses",
      "value": true
    },
    {
      "finding": "biopsy_shows_dlbcl",
      "value": true
    }
  ],
  "type": "composite_clinical"
}

Notes

Transformation rate ~7-15% over 10 years; outcomes after transformation depend on aggressive-lymphoma-pathway response.

Used By

Algorithms

ALGO-NLPBL-2L - ALGO-NLPBL-2L