Table 5. Grading and Staging of Acute Graft-Versus-Host Disease (GVHD)a
| Stage | Skin | Liver (bilirubin)b | GI/Gut (stool output/day)c |
| 0 | No GVHD rash | <2 mg/dL | Child: <10 mL/kg/d; Adult: <500 mL/d |
| 1 | Maculopapular rash <25% BSA | 2–3 mg/dL | Adult: 500–999 mL/dd; Child: 10–19.9 mL/kg/d; Persistent nausea, vomiting, or anorexia, with a positive upper GI biopsy |
| 2 | Maculopapular rash 25%–50% BSA | 3.1–6 mg/dL | Child: 20–30 mL/kg/d; Adult: 1000–1500 mL/d |
| 3 | Maculopapular rash >50% BSA | 6.1–15 mg/dL | Child: >30 mL/kg/d; Adult: >1500 mL/d |
| 4 | Generalized erythroderma plus bullous formation and desquamation >5% BSA | >15 mg/dL | Severe 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. |
