CLL/SLL with Rai stage III-IV (anemia Hb <11 g/dL or thrombocytopenia plt <100K from CLL...

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

ID	`RF-RAI-HIGH`
Type	Red flag
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	`DIS-CLL`
Sources	`SRC-ESMO-CLL-2024` `SRC-NCCN-BCELL-2025`

Red Flag Origin

Definition	CLL/SLL with Rai stage III-IV (anemia Hb <11 g/dL or thrombocytopenia plt <100K from CLL marrow infiltration) — meets treatment indication; supports BTKi or ven+G 1L
Clinical direction	intensify
Category	risk-score
Shifts algorithm	ALGO-CLL-1L

Trigger Logic

{
  "any_of": [
    {
      "finding": "cll_rai_stage",
      "value": "III"
    },
    {
      "finding": "cll_rai_stage",
      "value": "IV"
    },
    {
      "finding": "cll_rai_risk",
      "value": "high"
    }
  ],
  "type": "composite_score"
}

Notes

Rai III-IV (high-risk modified Rai) marks symptomatic disease: anemia from marrow infiltration (Hb <11 g/dL) or thrombocytopenia (plt <100K) by CLL — distinguish from autoimmune cytopenia which warrants steroids first. Median OS pre-targeted therapy was 18-24 mo; modern BTKi or ven+G has transformed outcomes (RESONATE-2, ELEVATE-TN, CLL14). Direction `intensify` flips watch-and-wait default to active treatment branch in CLL-1L. Overlaps with Binet C semantically (cytopenia from CLL).

Used By

Algorithms

ALGO-CLL-1L - ALGO-CLL-1L