Reduced pulmonary diffusing capacity (DLCO <60% predicted). Bleomycin, BCNU/carmustine, B...

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

ID	`RF-ORGAN-PULMONARY-DLCO-LOW`
Type	Red flag
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	None declared
Sources	`SRC-ESMO-HODGKIN-2024` `SRC-NCCN-BCELL-2025`

Red Flag Origin

Definition	Reduced pulmonary diffusing capacity (DLCO <60% predicted). Bleomycin, BCNU/carmustine, BEAM conditioning, gemcitabine in combination with thoracic RT, and ICI in patients with prior pneumonitis are relatively/absolutely contraindicated. Triggers AVD-without-bleomycin, alternative lymphoma conditioning (LEAM, FEAM, BeEAM), or omission of bleomycin from ABVD per RATHL.
Clinical direction	de-escalate
Category	organ-dysfunction

Trigger Logic

{
  "any_of": [
    {
      "comparator": "<",
      "finding": "dlco_percent",
      "threshold": 60
    }
  ],
  "type": "lab_value"
}

Notes

Bleomycin pulmonary toxicity is dose-dependent (cumulative >270 IU) and risk-elevated by baseline DLCO <60%, age >40, smoking, prior thoracic RT, renal dysfunction. RATHL trial (Johnson 2016) established PET2-negative-then-AVD safety, halving bleomycin exposure without PFS loss. For autoSCT conditioning: BEAM (BCNU 300 mg/m²) carries 10-20% pneumonitis at DLCO <60% — substitute LEAM (lomustine) or BeEAM (bendamustine) per institutional preference. For ICI: prior pneumonitis grade ≥2 contraindicates rechallenge.

Used By

No reverse references found in the YAML corpus.