Table 6. Grading and Staging of Acute Graft-Versus-Host Disease (GVHD)a

Stage SkinLiver (bilirubin)bGI/Gut (stool output per day)c
0 No GVHD rash<2 mg/dL Child: <10 mL/kg; adult: <500 mL
1 Maculopapular rash <25% BSA 2–3 mg/dLAdult: 500–999 mLd; child: 10–19.9 mL/kg; persistent nausea, vomiting, or anorexia, with a positive upper GI biopsy
2 Maculopapular rash 25%–50% BSA3.1–6 mg/dL Child: 20–30 mL/kg; adult: 1000–1500 mL
3 Maculopapular rash >50% BSA 6.1–15 mg/dLChild: >30 mL/kg; adult: >1500 mL
4 Generalized erythroderma plus bullous formation and desquamation >5% BSA >15 mg/dLSevere abdominal paine with or without ileus, or grossly bloody stool (regardless of stool volume)

BSA = body surface area; GI = gastrointestinal.

aChildren's Oncology Group/Pediatric Blood and Marrow Transplant Consortium consensus, adapted from the modified Glucksberg system.

bThere is no modification of liver staging for other causes of hyperbilirubinemia.

cFor GI staging: The adult stool output values should be used for patients weighing >50 kg. Use 3-day averages for GI staging based on stool output. If stool and urine are mixed, stool output is presumed to be 50% of total stool/urine mix.

dIf colon or rectal biopsy is positive, but stool output is <500 mL/day (<10 mL/kg/day), then consider as GI stage 0.

eFor stage 4 GI: the term severe abdominal pain will be defined as having both (a) pain control requiring treatment with opioids or an increased dose in ongoing opioid use; and (b) pain that significantly impacts performance status, as determined by the treating physician.

From: Childhood Hematopoietic Cell Transplantation (PDQ®)

Cover of PDQ Cancer Information Summaries
PDQ Cancer Information Summaries [Internet].
Bethesda (MD): National Cancer Institute (US); 2002-.

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