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Caution: IL-2 added to anti-GD2 therapy

Interleukin-2 was part of the original immunotherapy package but a large European trial showed it adds toxicity and no benefit, so it has been dropped.

HR-NBL1 R2: dinutuximab beta ± subcutaneous IL-2, 3-year EFS 60% vs 56%; grade ≥3 toxicity far higher with IL-2. Europe omits IL-2; COG has since removed it as well (ANBL1531).

Rationale
IL-2 expands regulatory T cells and causes capillary leak; NK-mediated ADCC is sufficiently supported by GM-CSF.
Evidence
Randomised phase 3 (HR-NBL1).

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