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Table 1 Guidelines for delay or discontinuation of IL-2: relative and absolute criteria

From: Radiotherapy as an immunological booster in patients with metastatic melanoma or renal cell carcinoma treated with high-dose Interleukin-2: evaluation of biomarkers of immunologic and therapeutic response

System Relative criteria Absolute criteria
Cardiac - Sinus tachycardia (120–130 beats per minutes); - Sinus tachycardia (>130 beats per minutes persists after correcting hypotension, fever and stopping dopamine);
   - Atrial fibrillation;
   - Supraventricular tachycardia;
   - Ventricular arrhythmia;
   - Elevated creatine kinase isoenzymes or troponin;
   - Electrocardiogram changes of ischemia;
Dermatologic --- - Moist desquamation;
Gastrointestinal - Diarrhea, up to 6 episodes/day - Diarrhea, > 6 episodes/day
  - Ileus/abdominal distension; - Severe abdominal distention affecting breathing;
  - Bilirubin >7 mg/dl; - Severe abdominal pain, unrelenting;
Hemodynamic - Maximum neosynephrine 1–1.5 mcg/kg/min; - Maximum neosynephrine 1.5-2 mcg/kg/min;
  - Maximum neosynephrine >0.5 mcg/kg/min; - Maximum neosynephrine >0.8 mcg/kg/min;
Hemorrhagic - Guiac + sputum, emesis, stool; - Frank blood sputum, emesis, stool;
  - Platelets 30,000-50,000/mm3; - Platelets <30,000/mm3;
Infections --- - Strong clinical suspicion or documented;
Muscoloskeletal - Weight gain >15%;  
  - Extremity tightness; - Extremity paresthesias;
Neurologic - Vivid dreams; - Hallucination;
  - Emotional lability; - Persistent crying;
   - Mental status changes not reversible in 2 hours;
   - Inability to subtract 7 s or spell “world” backwards
   disorientation;
Pulmonary - Resting shortness of breath; - >4 L O2 nasal cannula for saturation >95% or 40% O2 mask for saturation >95%;
  - 3-4 L O2 nasal cannula for saturation >95%; - Moist rates involving more than half of both lung fields;
  - Moist rates involving more than half of both lung fields; - Endotracheal intubation;
   - Pleural effusion requiring tap or chest tube;
Renal - Urine 80–160 ml/shift; - Urine <80 ml/shift;
  - Urine 10–20 ml/h; - Urine <10 ml/h;
  - Creatinine 2.5-2.9 mg/dl. - Creatinine >3 mg/dl.