Graft versus host disease (GVHD)

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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

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

  1. 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
  2. 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
  3. Rowlings PA, Przepiorka D, Klein JP, Gale RP, Passweg JR, Henslee-Downey PJ, Cahn JY, Calderwood S, Gratwohl A, SociƩ 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