Bulky mediastinal disease (>10 cm) and/or aaIPI ≥2 — favors DA-EPOCH-R over R-CHOP+RT per...

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

ID	`RF-PMBCL-HIGH-RISK-BIOLOGY`
Type	Red flag
Status	reviewed 2026-04-25 \| pending_clinical_signoff
Diseases	`DIS-PMBCL`
Sources	`SRC-ESMO-DLBCL-2024` `SRC-NCCN-BCELL-2025`

Red Flag Origin

Definition	Bulky mediastinal disease (>10 cm) and/or aaIPI ≥2 — favors DA-EPOCH-R over R-CHOP+RT per IELSG-26 / NCCN B-cell.
Clinical direction	investigate
Category	high-risk-biology

Trigger Logic

{
  "any_of": [
    {
      "comparator": ">=",
      "finding": "dominant_mediastinal_mass_cm",
      "threshold": 10
    },
    {
      "comparator": ">=",
      "finding": "aaipi_score",
      "threshold": 2
    },
    {
      "finding": "bulky_mediastinal_pmbcl",
      "value": true
    }
  ],
  "type": "composite_score"
}

Notes

Dunleavy NEJM 2013 phase-2 (DA-EPOCH-R 93% EFS) + IELSG-26 PET-driven response data form the evidence base for DA-EPOCH-R preference in bulky/high-IPI PMBCL.

Used By

No reverse references found in the YAML corpus.