Criteria for holding and stopping IL2#
| System | Relative criteria | Absolute criteria |
|---|---|---|
| Cardiovascular | Sinus tachycardia 100-130 BPM* | Sinus tachycardia > 130 BPM* |
| ECG indications of ischemia | ||
| Atrial fibrillation | ||
| Supraventricular tachycardia | ||
| Ventricular arrhythmias** | ||
| Elevated CKB-MB isoenzyme of troponin levels | ||
| Dermatologic | Moist desquamation | |
| Gastrointestinal | Diarrhea, 1000 ml/shift | Diarrhea 1000 ml/shift x 2 |
| Vomiting not responsive to medication | ||
| Ileus/abdominal distention | Severe abdominal distention affecting breathing | |
| Bilirubin > 7 mg/dL | Severe, unrelenting abdominal pain | |
| Hemodynamic#* | Maximum Phenylephrine 1-1.5 mcg/kg/min | Maximum Phenylephrine 1.5-2.0 mcg/kg/min |
| Minimum Phenylephrine > 0.5 mcg/kg/min | Minimum Phenylephrine > 0.8 mcg/kg/min | |
| Hemorrhagic | Sputum, emesis, or stool heme-positive | Frank blood in sputum, emesis, or stool |
| Platelets 30,000-50,000/mm3 | Platelets < 30,000 mm3 | |
| Infectious | Strong clinical suspicion or documented | |
| Musculoskeletal | Weight gain > 15% | |
| Extreme tightness | Extreme paresthesias | |
| Neurologic | Vivid dreams | Hallucinations |
| Mild anxiety | Persistent crying | |
| Mental status changes not reversible in 2 hours | ||
| Unable to subtract serial "7 s" or spell "WORLD" backward | ||
| Disorientation | ||
| Pulmonary | Resting shortness of breath | > 4 L O2 by nasal cannula or 40% by mask to maintain ≥ 95% O2 saturation |
| 3- 4 L O2 by nasal cannula for O2 saturation ≥ 95% | Intubation | |
| Rales 1/3 up chest | Moist rales ½ up chest | |
| Renal | Urine output 80-160 ml/shift | Urine < 80 ml/shift |
| Creatinine 2.5-2.9 mg/dL | Creatinine ≥ 3 mg/dL | |
| HCO3 ≤ 18 meq/dL |
Abbreviations: BPM, beats per minute; ECG, electrocardiogram.
*Persistent at the time of dosing after correcting hypotension, fever, and tachycardia and discontinuing dopamine.
**Including premature ventricular contractions, bigeminy, and tachycardia.
#In order to maintain acceptable BP and pulse criteria.
*Phenylephrine Max is during the interval, Min at the time of dosing.
#The above criteria should be assessed at the scheduled time of next dose after aggressive measures to correct toxicity have been undertaken.
If ≤ 3 relative criteria, delay dosing, continue corrective measures and administer another dose if recovered in < 24 hours.
If >3 relative criteria or an absolute criteria are observed stop IL-2 for the current cycle.