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Table 4. Staging of Acute Graft-Versus-Host Disease (GVHD)a
| Stage | Skin | Liver (bilirubin)b | GI/Gut (stool output per day)c | |
|---|---|---|---|---|
| Adult | Child | |||
| 0 | No GVHD rash | <2 mg/dL | <500 mL or <3 episodes/day | <10 mL/kg or <4 episodes/day |
| 1 | Maculopapular rash <25% BSA | 2–3 mg/dL | 500–999 mLd or 3–4 episodes/day | 10–19.9 mL/kg or 4–6 episodes/day; persistent nausea, vomiting, or anorexia, with a positive result from upper GI biopsy |
| 2 | Maculopapular rash 25%–50% BSA | 3.1–6 mg/dL | 1,000–1,500 mL or 5–7 episodes/day | 20–30 mL/kg or 7–10 episodes/day |
| 3 | Maculopapular rash >50% BSA | 6.1–15 mg/dL | >1,500 mL or >7 episodes/day | >30 mL/kg or >10 episodes/day |
| 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) | Severe abdominal paine with or without ileus, or grossly bloody stool (regardless of stool volume) |
BSA = body surface area; GI = gastrointestinal.
aAdapted from Harris et al.[74]
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 results of colon or rectal biopsy are 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.