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Table 5. Grading and Staging of Acute Graft-Versus-Host Disease (GVHD)a

Stage  Skin Liver (bilirubin)b GI/Gut (stool output/day)c 
0No GVHD rash<2 mg/dLChild: <10 mL/kg/d; Adult: <500 mL/d
1Maculopapular rash <25% BSA2–3 mg/dLAdult: 500–999 mL/dd; Child: 10–19.9 mL/kg/d; Persistent nausea, vomiting, or anorexia, with a positive upper GI biopsy
2Maculopapular rash 25%–50% BSA3.1–6 mg/dLChild: 20–30 mL/kg/d; Adult: 1000–1500 mL/d
3Maculopapular rash >50% BSA6.1–15 mg/dLChild: >30 mL/kg/d; Adult: >1500 mL/d
4Generalized erythroderma plus bullous formation and desquamation >5% BSA>15 mg/dLSevere abdominal paine with or without ileus, or grossly bloody stool (regardless of stool volume)

BSA = body surface area; GI = gastrointestinal.
aChildren's Oncology Group/Pediatric Blood and Marrow Transplant Consortium consensus, adapted from the modified Glucksberg system.
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 colon or rectal biopsy is 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.