Progressive disease

• Worsening clinical signs – see below
• Decreasing functional status
• Evidence of metastatic disease

Clinical signs

• Pain, nausea or vomiting
• Thrombosis or DIC
• Bone marrow involvement requiring transfusion

Disease stage

• Stage IV (any T,N,or M1) at initial diagnosis
• Progression of an earlier stage of disease with either of the following:
• Patient continues to decline despite definitive therapy
• The patient is refractory or refuses further treatment

Performance status

• Karnofsky score of 50% or less
• Karnofsky score of 70% or less, if patient has progressive disease on therapy, or declines therapy