Graft versus host disease
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==Glucksberg-Seattle acute graft versus host (GVHD) scores==[1] [2] [3] [4]
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 3.1-6 mg/dL
- Stage 3: Bilirubin 6.1-15.0 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
Overall grade
| 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 |
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.
- ↑ 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. (contains grading scale)
- ↑ PubMed