Key points
- Grade 1 mild, 2 moderate (limiting instrumental activities of daily living), 3 severe (limiting self-care or needing admission), 4 life-threatening, 5 death [1].
- Most holds and dose reductions in labels are written for grade 3 and above.
Haematological
| Adverse event | Grade 1 | Grade 2 | Grade 3 | Grade 4 |
|---|---|---|---|---|
| Neutropenia (ANC per µL) | Below normal to 1500 | 1000 to below 1500 | 500 to below 1000 | Below 500 |
| Thrombocytopenia (per µL) | Below normal to 75,000 | 50,000 to below 75,000 | 25,000 to below 50,000 | Below 25,000 |
| Anaemia (haemoglobin g/dL) | Below normal to 10 | 8 to below 10 | Below 8; transfusion needed | Life-threatening |
| Febrile neutropenia | — | — | ANC below 1000 with a temperature of 38.3, or 38 sustained for an hour [2] | Life-threatening |
Gastrointestinal
| Adverse event | Grade 1 | Grade 2 | Grade 3 | Grade 4 |
|---|---|---|---|---|
| Diarrhoea (above baseline) | Fewer than 4 times a day | 4 to 6 times | 7 times or more, incontinence, admission | Life-threatening |
| Oral mucositis | Asymptomatic or mild | Moderate pain not interfering with eating | Severe pain interfering with eating | Life-threatening |
| Nausea | Loss of appetite without change in eating habits | Reduced intake without significant weight loss | Inadequate intake; tube feeding or admission | — |
| Vomiting | No intervention needed | Outpatient IV fluids | Tube feeding, parenteral nutrition or admission | Life-threatening |
Neurological, skin, liver and kidney
| Adverse event | Grade 1 | Grade 2 | Grade 3 | Grade 4 |
|---|---|---|---|---|
| Peripheral sensory neuropathy | Asymptomatic | Moderate; limiting instrumental activities | Severe; limiting self-care | — |
| Hand-foot syndrome | Skin changes without pain | Skin changes with pain; limiting instrumental activities | Severe with pain; limiting self-care | — |
| Maculopapular rash | Less than 10% of body surface area | 10 to 30% | More than 30% with limitation of self-care | — |
| AST or ALT (normal baseline) | Up to 3 × the upper limit | Above 3 to 5 × | Above 5 to 20 × | Above 20 × |
| Bilirubin (normal baseline) | Up to 1.5 × the upper limit | Above 1.5 to 3 × | Above 3 to 10 × | Above 10 × |
| Increased creatinine | Up to 1.5 × the upper limit | Above 1.5 to 3 × | Above 3 to 6 × | Above 6 × |
| Fatigue | Relieved by rest | Not relieved by rest; limiting instrumental activities | Limiting self-care | — |
Related tools: ANC · QTc · immunotherapy toxicity
References
2 referencesShow all references, 1 with a study cardClose the reference list
Numbers in the text, such as [1], refer to these sources. Sources with a “Study card” button are summarised in the site’s evidence library.
- 1
- 2Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of america
This page is based on reputable scientific sources and was last updated on 28 October 2026. The content of this website is for educational and informational purposes only and does not replace consultation, diagnosis or treatment by a specialist physician. Consult your treating physician about any treatment decision.
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