Supplemental Table 1. Dose modifications for febrile neutropenia occurring anytime during treatment with gemcitabine

Grade 3 ANC < 1.0x109/L with fever ≥38.5°C / Grade 4 ANC < 1.0x109/L with fever ≥38.5°C and life threatening sepsis
1st occurrence / Gemcitabine 25% dose reduction / Stop treatment permanently unless it is in the best interest of the patient to treat with gemcitabine at 50% of original dose
2nd occurrence / Gemcitabine 50% dose reduction / Stop treatment permanently

Supplemental Table 2. Gemcitabine dose adjustments for neutropenia

Grade 2
1.0≤ANC<1.5 x109/L / Grade 3
0.5≤ANC<1.0 x109/L / Grade 4
ANC< 0.5 x109/L
1st occurrence / No dose adjustment / Gemcitabine 75% of original dose / Gemcitabine 50% dose reduction
2nd occurrence / No dose adjustment / Gemcitabine 50% of original dose / Off the protocol
3rd occurrence / No dose adjustment / No dose adjustment / Not applicable

* Chemotherapy should be delayed until ANC ≥1,500/ul and platelet ≥75,000/ul.

Supplemental Table 3. Gemcitabine dose adjustments for thrombocytopenia

Platelets
≥50 - < 75 x109/L / Platelets
≥10 - < 50 x109/L / Platelets
< 10 x109/L
1st occurrence / No dose adjustment / Gemcitabine 75% of original dose / Gemcitabine 50% of original dose
2nd occurrence / No dose adjustment / Gemcitabine 50% of original dose / Off the protocol
3rd occurrence / No dose adjustment / Off the protocol / Not applicable

Treatment cannot start unless toxicity (except anemia) is resolved to grade ≤1 (e.g. ANC >1.5 x109/L, Platelets > 75 x109/L)

Supplemental Table 4. Gemcitabine dose adjustments for non-hematologic adverse effects

Day 8 / Day 15 / Next cycle
Grade 1 / No / No / No
Grade 2 / No / No / No
Grade 3 / Omit / Omit / 75%
Grade 4 / Omit / Omit / off the protocol