T-ALL/T-LBL with anterior mediastinal mass causing airway compromise (stridor, orthopnea,...

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

ID	`RF-T-ALL-MEDIASTINAL-AIRWAY`
Type	Red flag
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	`DIS-T-ALL`
Sources	`SRC-BLAST-GOKBUGET-2018` `SRC-CALGB-10403-STOCK-2019` `SRC-NCCN-BCELL-2025`

Red Flag Origin

Definition	T-ALL/T-LBL with anterior mediastinal mass causing airway compromise (stridor, orthopnea, SVC syndrome features) or pericardial effusion with tamponade physiology — class-defining presentation in T-ALL
Clinical direction	hold
Category	organ-dysfunction
Shifts algorithm	ALGO-T-ALL-1L

Trigger Logic

{
  "any_of": [
    {
      "comparator": ">=",
      "finding": "anterior_mediastinal_mass_cm",
      "threshold": 10
    },
    {
      "finding": "stridor_or_airway_compromise",
      "value": true
    },
    {
      "finding": "orthopnea_supine_intolerance",
      "value": true
    },
    {
      "finding": "pericardial_effusion_tamponade",
      "value": true
    },
    {
      "finding": "svc_syndrome_present",
      "value": true
    }
  ],
  "type": "composite"
}

Notes

T-ALL/T-LBL anterior mediastinal mass is class-defining (~50-60% of T-ALL). Airway compromise + SVC syndrome are joint emergency presentations requiring HOLD on definitive induction — needs urgent steroids (prednisone or dexamethasone) to debulk, head-elevation, avoid supine GA. Per NCCN-BCELL ALL/LBL section: emergent steroid pre-phase before formal induction in symptomatic mediastinal mass. Per CALGB-10403: pediatric-inspired regimens begin with steroid pre-phase that addresses this. Direction HOLD because definitive induction is deferred until airway / SVC stabilized; priority 8 to win conflicts with TLS-emergency (which fires on the same patient). STUB — requires clinical co-lead signoff. Wiring suggestion: ALGO-T-ALL-1L step that branches on this RF to a steroid-pre-phase pathway before regimen selection.

Used By

No reverse references found in the YAML corpus.