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Biologia de alto risco em DLBCL NOS: duplo-expressor (MYC + BCL2 por IHC, sem rearranjo), T...

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IDRF-DLBCL-HIGH-RISK-BIOLOGY
TipoSinal de alerta
Estadoreviewed 2026-04-25 | pending_clinical_signoff
DoençasDIS-DLBCL-NOS
FontesSRC-ESMO-DLBCL-2024 SRC-NCCN-BCELL-2025

Origem da bandeira vermelha

DefiniçãoHigh-risk biology in DLBCL NOS: double-expressor (MYC + BCL2 by IHC, no rearrangement), TP53 mutation, or non-GCB cell-of-origin in elderly / high-IPI context. Distinct from HGBL "double-hit" which is its own entity (DIS-HGBL-DH) — but double-expressor remains DLBCL NOS and shifts toward intensified backbone.
Direcção clínicaintensificar
Categoriahigh-risk-biology
Algoritmo de deslocamentosALGO-DLBCL-1L

Lógica de Desencadeamento

{
  "any_of": [
    {
      "finding": "double_expressor_status",
      "value": true
    },
    {
      "finding": "tp53_mutation",
      "value": true
    },
    {
      "all_of": [
        {
          "finding": "cell_of_origin_hans",
          "value": "non-GCB"
        },
        {
          "finding": "high_ipi",
          "value": true
        }
      ]
    }
  ],
  "type": "biomarker"
}

Notas

Double-expressor (≈30% of DLBCL): inferior PFS/OS on R-CHOP; POLARIX subgroup analysis shows Pola-R-CHP benefit largest in non-GCB + double-expressor. TP53 mutation: PFS halved on R-CHOP; consider Pola-R-CHP and earlier consolidation discussion. Strict double-/ triple-hit (FISH break-apart) is captured by the separate DIS-HGBL-DH entity per WHO 5th classification, not here.

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Algoritmos

Capítulos do Manual

Indicação

Sinal de alerta