Refractory disease at end-of-induction MRI (any persistent enhancing lesion) or progressi...

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

ID	`RF-PCNSL-TRANSFORMATION-PROGRESSION`
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	Refractory disease at end-of-induction MRI (any persistent enhancing lesion) or progression during therapy — switch to salvage 2L pathway (R-temozolomide, ibrutinib, lenalidomide-based, or WBRT).
Clinical direction	investigate
Category	transformation-progression

Trigger Logic

{
  "any_of": [
    {
      "finding": "end_induction_mri_residual",
      "value": true
    },
    {
      "finding": "interim_progression_pcnsl",
      "value": true
    }
  ],
  "type": "imaging_finding"
}

Notes

Progression on HD-MTX-based induction is poor-prognosis; R/R PCNSL pathway (separate Algorithm) takes over. 1L decision_tree unaffected; surfaces as MDT-brief priority.

Used By

Algorithms

ALGO-PCNSL-2L - ALGO-PCNSL-2L