Toxicity | Grade 1 | Grade 2 | Grade 3 |
---|---|---|---|
Heart | Mild ECG abnormality, not requiring medical intervention; or noted heart enlargement on CXR with no clinical symptoms | Moderate ECG abnormalities requiring and responding to medical intervention; or requiring continuous monitoring without treatment; or congestive heart failure responsive to digitalis or diuretics | Severe ECG abnormalities with no or only partial response to medical intervention; or heart failure with no or only minor response to medical intervention: or decrease in voltage by more than 50% |
Bladder | Macroscopic haematuria after 2 days from last chemotherapy dose with no subjective symptoms of cystitis and not caused by infection | Macroscopic haematuria after 7 days from last chemotherapy dose not caused by infection; or haematuria after 2 days with subjective symptoms of cystitis not caused by infection | Haemorrhagic cystitis with frank blood, necessitating invasive local intervention with installation of sclerosing agents, nephrostomy or other surgical procedures |
Kidney | Increase in creatinine up to twice the baseline value | Increase in creatinine above twice baseline but not requiring dialysis | Requirement of dialysis |
Lung | Dyspnoea without CXR changes not caused by infection or congestive heart failure; or CXR showing isolated infiltrate or mild interstitial changes without symptoms not caused by infection or congestive heart failure | CXR with extensive localised infiltrate or moderate interstitial changes combined with dyspnoea and not caused by infection or CHF; or decrease of PO2 (>10% from baseline) but not requiring mechanical ventilation or >50% O2 on mask and not caused by infection | Interstitial changes requiring mechanical ventilator support or >50% oxygen on mask and not caused by infection or CHF |
Liver | Mild hepatic dysfunction with 2.0 mg/dL <bilirubin <6.0 mg/dL or weight gain >2.5% and <5% from baseline, of non-cardiac origin; or serum AST increase more than twofold but less than fivefold from lowest preconditioning | Moderate hepatic dysfunction with bilirubin >6 mg/dL <20 mg/dL; or serum AST increase more than fivefold from preconditioning; or clinical ascites or image-documented ascites >100 mL; or weight gain >5% from baseline of non-cardiac origin | Severe hepatic dysfunction with bilirubin >20 mg/dL; or hepatic encephalopathy; or ascites compromising respiratory function |
CNS | Somnolence but the patient is easily arousable and oriented after arousal | Somnolence with confusion after arousal; or other new objective CNS symptoms with no loss of consciousness not more easily explained by other medication, bleeding, or CNS infection | Seizures or coma not explained (documented) by other medication, CNS infection, or bleeding |
Stomatitis | Pain and/or ulceration not requiring a continuous intravenous narcotic drug | Pain and/or ulceration requiring a continuous intravenous narcotic drug (morphine drip) | Severe ulceration and/or mucositis requiring preventive intubation; or resulting in documented aspiration pneumonia with or without intubation |
GI toxicity | Watery stools >500 mL but <2000 mL every day not related to infection | Watery stools >2000 mL every day not related to infection; or macroscopic haemorrhagic stools with no effect on cardiovascular status not caused by infection; or subileus not related to infection | Ileus requiring nasogastric suction and/or surgery and not related to infection; or haemorrhagic enterocolitis affecting cardiovascular status and requiring transfusion |
AST, aspartate transaminase; CHF, congestive heart failure; CNS, central nervous system; CXR, chest X-ray; GI, gastrointestinal.