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Clinical Stage and Grade of Acute GVHD by Glucksberg et al

Purpose: To stage acute graft-versus-host disease (GVHD) based on the clinical examination of the patient.

Description

Acute graft-versus-host disease (GVHD) usually occurs 10-21 days after bone marrow transplantation. The clinical staging and grading of acute graft versus host disease (GVHD) can be made by evaluating the skin, liver, gastrointestinal tract and performance level of the patient.


Stages of GVHD by Organ System

 

Skin Findings

Stage

maculopapular rash < 25% of body surface

1

maculopapular rash 25-50% of body surface

2

generalized erythroderma

3

generalized erythroderma with bulla and desquamation

4

 

 

Liver Findings

Stage

bilirubin 2-3 mg/dL

1

bilirubin 3-6 mg/dL

2

bilirubin 6-15 mg/dL

3

bilirubin > 15 mg/dL

4

 

 

Intestinal Tract Findings

Stage

> 500 mL diarrhea per day

1

> 1000 mL diarrhea per day

2

> 1500 mL diarrhea per day

3

severe abdominal pain with/without ileus

4

 

 

Grade of Acute GVHD

 

Degree of Organ Involvement

Grade

• skin: rash stage 1-2

• intestinal tract involvement: none

• liver involvement: none

• clinical performance: no decrease

1

• skin: rash stage 1-3

• intestinal tract involvement: stage 1 AND/OR liver involvement: stage 1

• clinical performance: mild decrease

2

• skin: rash stage 2-3

• intestinal tract involvement: stage 2-3 AND/OR liver involvement: stage 2-3

• clinical performance: marked decrease

3

• skin: rash stage 2-4

• intestinal tract involvement: stage 2-4 AND/OR liver involvement: stage 2-4

• clinical performance: extreme decrease

4

 


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Specialty

Objective

ICD-10