Baseline organ dysfunction precluding standard FL regimens (BR / R-CHOP / R-Lenalidomide...

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

Origem da bandeira vermelha

Definição	Baseline organ dysfunction precluding standard FL regimens (BR / R-CHOP / R-Lenalidomide / G-bendamustine): LVEF <50% (anthracycline contraindicated in R-CHOP), CrCl <30 (cyclophosphamide / lenalidomide dose-modify), bilirubin >3× ULN (vincristine / doxorubicin metabolism), or significant pulmonary disease (DLCO <60% — bendamustine pneumonitis rare but reported).
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
    },
    {
      "comparator": "<",
      "finding": "dlco_percent",
      "threshold": 60
    }
  ],
  "type": "lab_value"
}

Notas

LVEF <50%: avoid R-CHOP; use BR or R-mono (rituximab single-agent — excellent option in low-burden / unfit indolent FL). CrCl <30: lenalidomide dose-reduce per renal-dosing table (10 mg q.d. if CrCl 30-60; 15 mg q.o.d. if CrCl <30); cyclophosphamide reduce 25-50%. Bendamustine has rare but real pulmonary toxicity (~1% pneumonitis) and reactivates HBV / HSV / VZV — pre-screening mandatory. CD20 antibody alone is highly active in low-tumor-burden FL (RESORT, PRIMA placebo arm) — frequent first-line option for organ-compromised.

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