T-ALL with CNS-2 (CSF blasts present, WBC <5/µL) or CNS-3 (CSF WBC ≥5/µL with blasts, or...

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

ID	`RF-T-ALL-CNS-LEUKEMIA`
Type	Red flag
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	`DIS-T-ALL`
Sources	`SRC-CALGB-10403-STOCK-2019` `SRC-NCCN-BCELL-2025`

Red Flag Origin

Definition	T-ALL with CNS-2 (CSF blasts present, WBC <5/µL) or CNS-3 (CSF WBC ≥5/µL with blasts, or cranial nerve palsy / parenchymal mass) status at diagnosis or relapse — mandates intensified IT/CNS-directed therapy
Clinical direction	intensify
Category	high-risk-biology

Trigger Logic

{
  "any_of": [
    {
      "finding": "csf_blasts_present",
      "value": true
    },
    {
      "comparator": ">=",
      "finding": "csf_wbc_per_ul",
      "threshold": 5
    },
    {
      "finding": "cranial_nerve_palsy",
      "value": true
    },
    {
      "finding": "cns_parenchymal_mass",
      "value": true
    },
    {
      "finding": "cns_status",
      "value": "CNS-3"
    }
  ],
  "type": "composite"
}

Notes

CNS-3 is the highest-risk CNS status; per NCCN ALL/LBL guideline, CNS-3 at diagnosis mandates cranial radiation (12-18 Gy) addition to standard IT therapy + adjustment of post-CR consolidation. Direction INTENSIFY — shifts indication toward pediatric-inspired regimens (CALGB-10403, GMALL) + cranial RT addition. Priority 20 (high but below airway/TLS emergencies). STUB — requires clinical co-lead signoff. Wiring suggestion: ALGO-T-ALL-1L step that branches to CNS-intensified consolidation indication.

Used By

No reverse references found in the YAML corpus.