Active or latent infection requiring resolution / prophylaxis before initiating WM therap...

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

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

Red Flag Origin

Definition	Active or latent infection requiring resolution / prophylaxis before initiating WM therapy: HBsAg-positive (high HBV reactivation risk on rituximab + bendamustine combination), anti-HBc-positive (occult HBV), HCV-RNA-positive (HCV-driven cryoglobulinemia / WM associations require hepatology coordination), HIV-positive, active TB, or hypogammaglobulinemia with recurrent infections (consider IVIG before BTKi/anti-CD20).
Clinical direction	hold
Category	infection-screening

Trigger Logic

{
  "any_of": [
    {
      "finding": "hbsag",
      "value": "positive"
    },
    {
      "finding": "anti_hbc_total",
      "value": "positive"
    },
    {
      "finding": "hcv_rna",
      "value": "positive"
    },
    {
      "finding": "hiv_status",
      "value": "positive"
    },
    {
      "finding": "active_tb",
      "value": true
    },
    {
      "all_of": [
        {
          "comparator": "<",
          "finding": "igg_g_l",
          "threshold": 4.0
        },
        {
          "finding": "recurrent_infections",
          "value": true
        }
      ]
    }
  ],
  "type": "lab_value"
}

Notes

HBsAg+ with planned BR (bendamustine + rituximab — current standard per StiL elderly WM data): reactivation risk highest among WM regimens; entecavir/tenofovir prophylaxis from –7d through +12-18 mo. anti-HBc+ HBsAg-negative on bendamustine: monitor HBV-DNA q1-3mo or pre-emptive prophylaxis. HCV+ patients: defer DAA cure pre-treatment if disease tempo allows (WM is indolent — virtually always feasible). WM patients are frequently hypogammaglobulinemic at baseline (paradox: monoclonal IgM often normal or elevated, but polyclonal IgG/IgA suppressed) — IVIG (0.4 g/kg q3-4 weeks) for symptomatic recurrent infection. PJP prophylaxis routine on bendamustine + ongoing BTKi maintenance.

Used By

No reverse references found in the YAML corpus.