T-ALL with hyperleukocytosis (WBC ≥100 K/µL), spontaneous tumor lysis (LDH >2× ULN, uric...

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

ID	`RF-T-ALL-EMERGENCY-TLS-LEUKOSTASIS`
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 hyperleukocytosis (WBC ≥100 K/µL), spontaneous tumor lysis (LDH >2× ULN, uric acid >7.5 mg/dL, hyperphosphatemia, hyperkalemia, hypocalcemia) or symptomatic leukostasis at diagnosis — requires emergency stabilization before induction
Clinical direction	hold
Category	organ-dysfunction
Shifts algorithm	ALGO-T-ALL-1L

Trigger Logic

{
  "any_of": [
    {
      "comparator": ">=",
      "finding": "wbc_k_ul",
      "threshold": 100
    },
    {
      "comparator": ">",
      "finding": "ldh_ulnratio",
      "threshold": 2
    },
    {
      "comparator": ">",
      "finding": "uric_acid_mg_dl",
      "threshold": 7.5
    },
    {
      "finding": "leukostasis_symptoms",
      "value": true
    },
    {
      "finding": "tls_active",
      "value": true
    },
    {
      "comparator": ">",
      "finding": "potassium_mmol_l",
      "threshold": 5.5
    }
  ],
  "type": "composite"
}

Notes

T-ALL hyperleukocytosis + TLS is high-frequency (T-ALL median WBC at diagnosis ~50-100K). Per NCCN: rasburicase IV 0.2 mg/kg + IV hydration + electrolyte management before steroid pre-phase / induction. Per CALGB-10403: stepwise cytoreduction with steroid pre-phase to mitigate acute TLS. Direction HOLD; priority 10 (matches AML emergency RF). STUB — requires clinical co-lead signoff.

Used By

No reverse references found in the YAML corpus.