Patient has never received cumulative cardio-toxic therapy (anthracycline, mitoxantrone,...

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

ID	`RF-OBLIGATE-CARDIO-TOXIC-NAIVE`
Type	Red flag
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	None declared
Sources	`SRC-ESMO-DLBCL-2024` `SRC-NCCN-BCELL-2025`

Red Flag Origin

Definition	Patient has never received cumulative cardio-toxic therapy (anthracycline, mitoxantrone, trastuzumab, mediastinal/cardiac radiation). Cumulative anthracycline exposure budget remains intact; full standard regimens (R-CHOP, AC-T, ABVD, BEACOPP) are dose-feasible without dose-cap concern. Distinct from RF-ORGAN-CARDIAC-LVEF-LOW (which gates on functional reserve regardless of prior exposure).
Clinical direction	intensify
Category	prior-therapy-class

Trigger Logic

{
  "all_of": [
    {
      "finding": "prior_anthracycline_received",
      "value": false
    },
    {
      "finding": "prior_trastuzumab_received",
      "value": false
    },
    {
      "finding": "prior_mediastinal_rt",
      "value": false
    }
  ],
  "type": "composite_score"
}

Notes

Cumulative anthracycline cardiotoxicity is dose-dependent: doxorubicin ≥250 mg/m² lifetime — significant CHF risk, ≥450 mg/m² — high risk (Swain 2003); epirubicin equivalent ≈ 0.7x doxorubicin; idarubicin ≈ 4x doxorubicin per mg. Standard R-CHOP delivers 300 mg/m² across 6 cycles — leaves headroom for relapse/salvage. Patients who received AC-T (240 mg/m² doxorubicin) for breast then progress to lymphoma have ~60 mg/m² remaining safely; substitute liposomal doxorubicin or R-CEOP. Trastuzumab cardiotoxicity is reversible (unlike anthracycline) but co-administration with anthracycline contraindicated; staggered AC→T → trastuzumab standard. Mediastinal RT (Hodgkin survivor) doubles anthracycline cardiotoxicity risk per equivalent dose.

Used By

Red flag

RF-ORGAN-CARDIAC-LVEF-LOW - Reduced left ventricular ejection fraction (LVEF <50% by echocardiogram or MUGA). Anthrac...