Glucksberg acute graft versus host (GVHD) scores
Skin
- Stage 0: No rash
- Stage 1: Maculopapular rash <25% of body surface area
- Stage 2: Maculopapular rash on 25-50% of body surface area
- Stage 3: Generalized erythroderma
- Stage 4: Generalized erythroderma with bullous formation and desquamation
Liver
- Stage 0: Bilirubin <2 mg/dL
- Stage 1: Bilirubin 2-3 mg/dL
- Stage 2: Bilirubin 3.01-6 mg/dL
- Stage 3: Bilirubin 6.01-15.0 mg/dL
- Stage 4: Bilirubin >15 mg/dL
GI
- Stage 0: No diarrhea, or diarrhea <500 mL/day
- Stage 1: Diarrhea 500-999 mL/day
- Stage 2: Diarrhea 1000-1499 mL/day
- Stage 3: Diarrhea >1500 mL/day
- Stage 4: Severe abdominal pain, with or without ileus
Glucksberg grade
The grade is the highest level which the patient reaches based on separate skin, liver, and GI staging.
| Overall grade
|
I
|
II
|
III
|
IV
|
| Skin
|
1-2
|
1-3
|
2-3
|
2-4
|
| GI
|
0
|
1
|
2-3
|
2-4
|
| Liver
|
0
|
1
|
2-4
|
2-4
|
| Karnofsky performance scale
|
90-100%
|
70-80%
|
50-60%
|
30-40%
|
IBMTR severity index
The severity is the highest level which the patient reaches based on separate skin, liver, and GI staging.
| Overall grade
|
A
|
B
|
C
|
D
|
| Skin
|
1
|
2
|
3
|
4
|
| GI
|
0
|
1-2
|
3
|
4
|
| Liver
|
0
|
1-2
|
3
|
4
|
Chronic GVHD
Localized
- Localized skin and/or liver dysfunction due to chronic GVHD
Extensive
- Generalized skin involvement or localized skin and/or liver dysfunction due to chronic GVHD plus at least one of the following:
- Liver biopsy showing cirrhosis, chronic aggressive hepatitis, bridging necrosis
- Eye involvement, defined as Schirmer's test with <5 mm wetting
- Involvement of oral mucosa on lip biopsy or minor salivary glands
- Other organ involvement
- Overall severity categories: mild/moderate/severe
References
- Thomas E, Storb R, Clift RA, Fefer A, Johnson FL, Neiman PE, Lerner KG, Glucksberg H, Buckner CD. Bone-marrow transplantation (first of two parts). N Engl J Med. 1975 Apr 17;292(16):832-43 link to original article PubMed
- Thomas ED, Storb R, Clift RA, Fefer A, Johnson L, Neiman PE, Lerner KG, Glucksberg H, Buckner CD. Bone-marrow transplantation (second of two parts). N Engl J Med. 1975 Apr 24;292(17):895-902 link to original article (contains staging scale) PubMed
- Rowlings PA, Przepiorka D, Klein JP, Gale RP, Passweg JR, Henslee-Downey PJ, Cahn JY, Calderwood S, Gratwohl A, Socié G, Abecasis MM, Sobocinski KA, Zhang MJ, Horowitz MM. IBMTR Severity Index for grading acute graft-versus-host disease: retrospective comparison with Glucksberg grade. Br J Haematol. 1997 Jun;97(4):855-64. link to original article PubMed