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Linfoma de Burkitt com síndrome de lise tumoral ativa ou iminente no diagnóstico: LDH > 2× LSN,...

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Origem da bandeira vermelha

Lógica de Desencadeamento

{
  "any_of": [
    {
      "comparator": ">",
      "finding": "ldh_ulnratio",
      "threshold": 2
    },
    {
      "comparator": ">",
      "finding": "uric_acid_mg_dl",
      "threshold": 7.5
    },
    {
      "comparator": ">",
      "finding": "potassium_mmol_l",
      "threshold": 5.5
    },
    {
      "comparator": ">",
      "finding": "phosphate_mg_dl",
      "threshold": 4.5
    },
    {
      "comparator": ">",
      "finding": "creatinine_mg_dl",
      "threshold": 1.5
    },
    {
      "finding": "tls_active",
      "value": true
    }
  ],
  "type": "composite"
}

Notas

Per NCCN Burkitt v.X.2025 §BURK-A: rasburicase mandatory for Burkitt pre-cycle-1; allopurinol insufficient for high-risk. ESMO-Burkitt 2024 echoes: rasburicase 0.2 mg/kg IV daily ×3-5 days, IV hydration 3 L/m²/day. Burkitt has highest TLS incidence among lymphomas (>30% high-risk). Direction HOLD on regimen start until uric acid <7.5, potassium <5.0, phosphate <4.5, creatinine baseline restored. Priority 10. Note this is a Burkitt-specific complement to RF-UNIVERSAL-TLS-RISK (which is intensify, surfaces supportive care without holding); this disease- specific HOLD is needed because Burkitt cycle 1 reduction-phase (COP/cyclophosphamide-vincristine-prednisone) sits between universal TLS-prophylaxis and definitive induction. STUB — requires clinical co-lead signoff.

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