Detectable or rising plasma EBV-DNA (BIO-EBV-DNA, quantitative PCR) after completion of d...

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

ID	`RF-NPC-EBV-DNA-POST-TREATMENT-SURVEILLANCE`
Type	Red flag
Status	reviewed 2026-07-11 \| pending_clinical_signoff
Diseases	`DIS-NPC`
Sources	`SRC-EBV-DNA-NPC-LIN-2004` `SRC-NCCN-HNSCC-2025`

Red Flag Origin

Definition	Detectable or rising plasma EBV-DNA (BIO-EBV-DNA, quantitative PCR) after completion of definitive treatment (concurrent chemoradiation +/- induction, or systemic 1L therapy) for nasopharyngeal carcinoma. Post-treatment plasma EBV-DNA is a validated prognostic/surveillance biomarker in NPC — persistent detectability or a rising trend can precede radiographic relapse by weeks to months, and should prompt accelerated re-staging workup rather than waiting for the routine imaging interval.
Clinical direction	investigate
Category	transformation-progression

Trigger Logic

{
  "any_of": [
    {
      "finding": "post_treatment_ebv_dna_detectable",
      "value": true
    },
    {
      "finding": "post_treatment_ebv_dna_rising",
      "value": true
    }
  ],
  "type": "biomarker_threshold"
}

Notes

Informational/surveillance-stage RedFlag — NOT currently wired into ALGO-NPC-1L's decision tree (that algorithm covers 1L treatment selection only; no dedicated NPC post-treatment-surveillance or 2L/relapse algorithm has been authored yet — Phase 4 backlog item). Referenced from IND-NPC-1L-LOCALLY-ADVANCED-CCRT and IND-NPC-1L-METASTATIC-GC-PD1 notes as the biomarker basis for post-treatment monitoring. Underlying quantitative biomarker: BIO-EBV-DNA (existing entity — reused, not duplicated), measured via TEST-EBV-VIRAL-LOAD. Finding keys post_treatment_ebv_dna_detectable / post_treatment_ebv_dna_rising are NEW free-text finding keys — no questionnaire currently exists for DIS-NPC to populate them (quest_npc_*.yaml absent), consistent with the "honest finding" / "mechanical rewire" pattern used elsewhere in this KB when a finding key is asserted before its questionnaire wiring exists. STUB pending Clinical Co-Lead sign-off (CHARTER §6.1, dev-mode-exempted).

Used By

Algorithms

ALGO-NPC-1L - ALGO-NPC-1L

Diseases

DIS-NPC - Nasopharyngeal carcinoma (NPC)

Indications

IND-NPC-1L-LOCALLY-ADVANCED-CCRT - IND-NPC-1L-LOCALLY-ADVANCED-CCRT

Sources

SRC-EBV-DNA-NPC-LIN-2004 - Quantification of plasma Epstein-Barr virus DNA in patients with advanced nasopharyngeal...