Ifosfamide contraindicated or high-risk in relapsed/refractory Burkitt lymphoma 2L salvag...

Детермінований перегляд YAML-сутності з джерельної бази. Клінічний авторитет лишається за вказаними source ID та статусом клінічного sign-off.

ID	`RF-BURKITT-IFOS-CONTRAINDICATED`
Тип	Тривожна ознака
Статус	переглянуто 2026-05-08
Хвороби	`DIS-BURKITT`
Джерела	`SRC-ESMO-BURKITT-2024` `SRC-NCCN-BCELL-2025`

Походження тривожної ознаки

Визначення	Ifosfamide contraindicated or high-risk in relapsed/refractory Burkitt lymphoma 2L salvage, routing to R-DHAP (cisplatin-based) over R-ICE (ifosfamide-based). Three clinical scenarios: (1) Prior hemorrhagic cystitis — any prior ifosfamide- or cyclophosphamide-related hemorrhagic cystitis is a contraindication to further ifosfamide even with mesna; residual mucosal damage increases bleeding risk; (2) Pelvic RT field overlap — prior irradiation to bladder field dramatically increases ifosfamide-related bladder toxicity; avoid; (3) Pre-existing peripheral neuropathy grade ≥2 — ifosfamide causes both peripheral and central neuropathy; additional neurotoxicity risk unacceptable when baseline neuropathy already impairs function; (4) Bladder outlet obstruction, single kidney, or other bladder structural contraindication to mesna- protected ifosfamide. In these scenarios R-DHAP (dexamethasone 4...
Клінічний напрям	de-escalate
Категорія	fitness-eligibility
Змінює алгоритм	ALGO-BURKITT-2L

Логіка спрацьовування

{
  "any_of": [
    {
      "finding": "prior_hemorrhagic_cystitis",
      "value": true
    },
    {
      "finding": "hemorrhagic_cystitis_history",
      "value": true
    },
    {
      "finding": "ifosfamide_contraindicated",
      "value": true
    },
    {
      "finding": "pelvic_rt_bladder_field",
      "value": true
    },
    {
      "finding": "prior_pelvic_radiotherapy",
      "value": true
    },
    {
      "comparator": ">=",
      "finding": "peripheral_neuropathy_grade",
      "threshold": 2
    },
    {
      "comparator": ">=",
      "finding": "neuropathy_grade",
      "threshold": 2
    },
    {
      "finding": "baseline_neuropathy",
      "value": "grade2"
    },
    {
      "finding": "baseline_neuropathy",
      "value": "grade3"
    },
    {
      "finding": "bladder_dysfunction",
      "value": true
    },
    {
      "finding": "bladder_outlet_obstruction",
      "value": true
    },
    {
      "finding": "single_kidney",
      "value": true
    }
  ],
  "type": "treatment_contraindication"
}

Нотатки

Step 2 handles the reverse routing: CrCl <50 mL/min / hearing loss / prior cisplatin toxicity → R-ICE preferred (uses carboplatin AUC-dose). Step 3 (this RF) handles the inverse: ifosfamide-specific contraindications → R-DHAP preferred. Both steps reference RF-BURKITT-ORGAN-DYSFUNCTION (which already fires on renal/hepatic dysfunction) — this RF captures the ifosfamide-specific history and neuropathy sub-criteria not covered by the organ-dysfunction RF. Step 1 pre-screens for transplant-ineligible patients (frailty + organ dysfunction + infection); this RF only fires after step 1 is negative (patient IS eligible for salvage). CORAL trial note: R-ICE and R-DHAP showed similar overall salvage rates (~63% ORR); the choice is driven purely by toxicity avoidance. Draft pending two-reviewer clinical co-lead signoff (CHARTER §6.1).

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Algorithms

ALGO-BURKITT-2L - ALGO-BURKITT-2L