PTCL NOS primary-refractory disease (no CR after induction) OR early relapse <12 months p...

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

ID	`RF-PTCL-NOS-TRANSFORMATION-PROGRESSION`
Type	Red flag
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	`DIS-PTCL-NOS`
Sources	`SRC-ESMO-PTCL-2024` `SRC-NCCN-BCELL-2025`

Red Flag Origin

Definition	PTCL NOS primary-refractory disease (no CR after induction) OR early relapse <12 months post-induction OR rapid progression — high-risk subset routes to single-agent salvage (romidepsin, pralatrexate, belinostat, gemcitabine ± brentuximab if CD30+) with intent to bridge to autoSCT (CR2) or alloSCT (younger fit refractory).
Clinical direction	intensify
Category	transformation-progression

Trigger Logic

{
  "any_of": [
    {
      "finding": "ptcl_primary_refractory",
      "value": true
    },
    {
      "finding": "ptcl_early_relapse_lt_12mo",
      "value": true
    },
    {
      "finding": "rapid_progression",
      "value": true
    },
    {
      "finding": "interim_pet_deauville_4_5",
      "value": true
    }
  ],
  "type": "composite_clinical"
}

Notes

PTCL NOS has dismal r/r outcomes — median OS ~6 mo without HCT. CD30+ subset: brentuximab vedotin monotherapy ORR 41% per Horwitz Blood 2014. Romidepsin (Pralatrexate, Belinostat) — ORRs 25-30% but durable CR uncommon. Best survival in r/r PTCL: salvage to CR2 followed by alloSCT (transplant-eligible only) — 3y OS ~50% in responders. AutoSCT consolidation in CR1 standard for high-risk PTCL NOS per Nordic NLG-T-01. Clinical-trial enrollment strongly encouraged in r/r setting given paucity of effective options.

Used By

No reverse references found in the YAML corpus.