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Kufe DW, Pollock RE, Weichselbaum RR, et al., editors. Holland-Frei Cancer Medicine. 6th edition. Hamilton (ON): BC Decker; 2003.

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Holland-Frei Cancer Medicine. 6th edition.

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Table 69-3Clinical staging and grading of GVHD

Acute GVHD
StageSkinaLiverbGutb
1maculopapular rash < 25%bilirubin 2–3 mg/dLdiarrhea 500–1000mL or persistent nauseac
2maculopapular rash 25–50%bilirubin 3–6 mg/dLdiarrhea 1000–1500 mL
3generalized erythrodermabilirubin 6–15 mg/dLdiarrhea > 1500 mL
4desquamation and bullabilirubin >15 mg/dLSevere abdominal pain or ileus
OverallGradeaSeveritySkinLiverGut
0None000
IMild1–200
IIModerate3or1or1
IIISevere2–3or2–3
IVbLife threatening4or4or4
Grading of Chronic GVHD
Limited ExtensiveLocalized skin involvement and/or hepatic dysfunction
1. Generalized skin involvement or
2. Localized skin involvement and/or hepatic dysfunction, plus any of the following:
 a. liver histology showing chronic aggressive hepatitis, bridging necrosis or cirrhosis
 b. eye involvement (Schirmer's test < 5 mm wetting)
 c. involvement of mucosalivary glands or oral mucosa
 d. involvement of any other target organ
a

= extents determined by rule of nines or burn chart;

b

= downgrade one stage for additional causes of elevated bilirubin or diarrhea;

c

= requires histologic evidence of GVHD in the stomach or duodenum; GVHD = graft-versus-host disease.

Sources: Glucksberg H, et al117; Przepiorka D, et al.118

a

= minimal organ stage required to determine grade;

b

= grade IV may also be determined with lower organ involvement with extreme decrease in performance status.

Source: Sullivan KM, et al.333

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