AITL com disfunção dos órgãos no início do estudo, excluindo a dose completa de CHOEP/CHP-Bv: FEVE < 50% (ant...

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ID	`RF-AITL-ORGAN-DYSFUNCTION`
Tipo	Sinal de alerta
Estado	reviewed 2026-04-27 \| pending_clinical_signoff
Doenças	`DIS-AITL`
Fontes	`SRC-ESMO-PTCL-2024` `SRC-NCCN-BCELL-2025`

Origem da bandeira vermelha

Definição	AITL with baseline organ dysfunction precluding full-dose CHOEP / CHP-Bv: LVEF <50% (anthracycline contraindicated; brentuximab-vedotin still OK but CHP backbone keeps doxorubicin), CrCl <30 mL/min (cyclophosphamide + etoposide dose constraints), bilirubin >3× ULN (vincristine / doxorubicin metabolism), or active autoimmune hemolytic anemia driving hemodynamic instability (AITL hallmark — DAT+ AIHA can produce profound anemia distinct from cytopenias due to marrow involvement).
Direcção clínica	de escalonamento
Categoria	disfunção de órgãos

Lógica de Desencadeamento

{
  "any_of": [
    {
      "comparator": "<",
      "finding": "lvef_percent",
      "threshold": 50
    },
    {
      "comparator": "<",
      "finding": "creatinine_clearance_ml_min",
      "threshold": 30
    },
    {
      "comparator": ">=",
      "finding": "bilirubin_ratio_to_uln",
      "threshold": 3
    },
    {
      "finding": "active_uncontrolled_organ_failure",
      "value": true
    },
    {
      "all_of": [
        {
          "finding": "aiha_present",
          "value": true
        },
        {
          "comparator": "<",
          "finding": "hemoglobin_g_dl",
          "threshold": 7.0
        }
      ]
    }
  ],
  "type": "composite"
}

Notas

LVEF <50%: substitute brentuximab-CHP only if CD30+ (still has doxorubicin — discuss liposomal-doxorubicin substitution or gemcitabine-based regimen); for CD30-negative AITL with cardiac contraindication consider GEM-P or pralatrexate. CrCl <30: reduce cyclophosphamide 25-50% per renal-dosing protocol; etoposide 25% reduction. Bilirubin >3× ULN: hold vincristine / doxorubicin until cause identified (hepatic infiltration vs cholestasis). Active AIHA with profound anemia: stabilize with transfusion + steroids ± rituximab before initiating T-cell-directed induction; AITL-driven AIHA often improves with prednisone-containing chemo backbone.

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