aGvHD
Glucksberg and IBMTR Acute GVHD Grading     Organ staging and overall grading of acute graft versus host disease
                  1. Determine aGVHD stage for each target organ (skin, liver and gut)      
Value % Skin Stage
Skin stage Body surface area involved by maculopapular rash
Body surface area involved by maculopapular rash
1 <25%
2 25 - 50%
3 > 50% or generalised erythroderma
4 generalised erythroderma with bullous formation or desquamation
Value Liver Stage
Liver stage Bilirubin in μmol/L * Bilirubin in mg/dL *
Bilirubin in μmol/L *
1 34 – 50 (or AST 150-750 U/L) 2 - 3 (or AST 150-750 U/L)
Bilirubin in mg/dL *
2 51-102 > 3 – 6
3 103 – 255 > 6 – 15
4 > 255 > 15
* Downgrade by one stage if additional cause of hyperbilirubinemia documented
Value Gut Stage
Gut stage Daily stool volume
Daily stool volume ml/kg
1 > 30 mL/kg or > 500mL*
Daily stool volume mL
2 > 60 mL/kg or > 1000mL
3 > 90 mL/kg or > 1500 mL
4 > 2000 mL/day or severe abdominal pain +/- ileus
* Persistent nausea with histologic evidence of stomach or duodenal aGVHD counts as stage 1 gut
                             
Computation of IBMTR and Glucksberg grades from organ stage         2. Determine overall aGVHD grade using the Glucksberg or IBMTR system
IBMTR grade Glucksberg grade Skin Intestine Liver         Overall grade (Glucksberg) Criteria 1 year mortality (odds ratio compared to no GVHD)4
A I 1 0 0
I Skin stage 1 or 2 only (no liver or gut aGVHD) 00:08
B I 2 0 0
II Up to stage 1 liver or gut, up to stage 3 skin 00:08
B II 0-2 1 0-1
III Up to stage 4 liver, up to stage 3 in any other organ 02:02
B II 0-2 0-1 1         IV Stage 4 skin or gut, ECOG/WHO performance status 4 or Karnofsky performance score < 30% 13:01
C II 3 1 0-1         Overall grade (IBMTR) Criteria 1 year mortality (odds ratio compared to no GVHD)4
C II 3 0-1 1
A Stage 1 skin only 00:08
C II 3 0 0
B Maximum stage 2 in any organ 00:08
B III 0-2 2 0-2
C Maximum stage 3 in any organ 01:04
B III 0-2 0-2 2
D Stage 4 in any organ 12:03
C III 0-3 0-3 2-3
C III 3 2-3 0-3
D III 0-3 0-3 4
D IV 0-3 4 0-4
D IV 4 0-4 0-4
In the Glucksberg system, any patient with a Karnofsky scale score of less than 30 is grade IV.