Renal dysfunction (CrCl <50 mL/min) — high-dose methotrexate (HD-MTX, ≥3 g/m²) backbone o...
Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.
| ID | RF-PCNSL-ORGAN-DYSFUNCTION |
|---|---|
| Type | Red flag |
| Status | reviewed 2026-04-25 | pending_clinical_signoff |
| Diseases | DIS-PCNSL |
| Sources | SRC-ESMO-DLBCL-2024 SRC-NCCN-BCELL-2025 |
Red Flag Origin
| Definition | Renal dysfunction (CrCl <50 mL/min) — high-dose methotrexate (HD-MTX, ≥3 g/m²) backbone of all PCNSL 1L regimens contraindicated; transition to non-MTX regimen or refer to specialized center. |
|---|---|
| Clinical direction | hold |
| Category | organ-dysfunction |
| Shifts algorithm | ALGO-PCNSL-1L |
Trigger Logic
{
"any_of": [
{
"comparator": "<",
"finding": "creatinine_clearance_ml_min",
"threshold": 50
},
{
"comparator": "<",
"finding": "egfr_ml_min",
"threshold": 50
}
],
"type": "lab_value"
}
Notes
HD-MTX requires CrCl ≥50 mL/min for safe clearance; below that, MTX accumulates and causes severe nephrotoxicity / mucositis / myelosuppression. Non-MTX salvage options (R-temozolomide, WBRT alone) carry inferior outcomes — this is a hold/refer decision.
Used By
Algorithms
ALGO-PCNSL-1L- ALGO-PCNSL-1LALGO-PCNSL-2L- ALGO-PCNSL-2L
Indications
IND-PCNSL-2L-RMPV-SALVAGE- IND-PCNSL-2L-RMPV-SALVAGE