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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

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- 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

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- 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.