Late hepatotoxicity after treatment for childhood cancer

Table 1 Grading of hepatotoxicity by the common terminology criteria of adverse events v5

Parameter/CTCAE term	Grade 1	Grade 2	Grade 3	Grade 4	Grade 5
Alanine aminotransferase increased	> ULN - 3.0 × ULN if baseline was normal; 1.5-3.0 × baseline if baseline was abnormal	> 3.0-5.0 × ULN ALT and/or AST > ULN - 3.0 × ULN if baseline was normal; 1.5-3.0 × baseline if baseline was abnormal	> 5.0-20.0 × ULN if baseline was normal; > 5.0-20.0 × baseline if baseline was abnormal	> 20.0 × ULN if baseline was normal; > 20.0 × baseline if baseline was abnormal
Alkaline phosphatase increased	> ULN - 2.5 × ULN if baseline was normal; 2.0-2.5 × baseline if baseline was abnormal	> 2.5-5.0 × ULN if baseline was normal; > 2.5-5.0 × baseline if baseline was abnormal	> 5.0-20.0 × ULN if baseline was normal; > 5.0-20.0 × baseline if baseline was abnormal	> 20.0 × ULN if baseline was normal; > 20.0 × baseline if baseline was abnormal
Aspartate aminotransferase increased	> ULN - 3.0 × ULN if baseline was normal; 1.5-3.0 × baseline if baseline was abnormal	> 3.0-5.0 × ULN if baseline was normal; > 3.0-5.0 × baseline if baseline was abnormal	> 5.0-20.0 × ULN if baseline was normal; > 5.0-20.0 × baseline if baseline was abnormal	> 20.0 × ULN if baseline was normal; > 20.0 × baseline if baseline was abnormal
Blood bilirubin increased	> ULN - 1.5 × ULN if baseline was normal; > 1.0-1.5 × baseline if baseline was abnormal	> 1.5-3.0 × ULN if baseline was normal; > 1.5-3.0 × baseline if baseline was abnormal	> 3.0-10.0 × ULN if baseline was normal; > 3.0-10.0 × baseline if baseline was abnormal	> 10.0 × ULN if baseline was normal; > 10.0 × baseline if baseline was abnormal
Hepatic failure	–	–	Asterixis; mild encephalopathy; drug-induced liver injury; limiting self care ADL	Life-threatening consequences; moderate to severe encephalopathy; coma	Death
Hepatic necrosis				Life-threatening consequences; urgent invasive intervention indicated	Death

ADL: Activities of daily living; CTCAE: Common terminology criteria of adverse events; ULN: Upper limit of normal; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase.