Table 1. Acute GVHD Grading Criteria.

The standard GVHD grading criteria was developed by Glucksberg in 1974 [146], and then revised at the 1994 Consensus Conference in Keystone [147]. The grading system did not initially take into consideration the staging of the GI tract for pediatric patients. However, most pediatric centers have adopted the modified Glucksberg grading scale and adjusted the staging of the GI tract to be based on volume per kilogram of body weight.

Stage	Skin	Liver (bilirubin)	GI tract (stool output/day)
0	No GVHD rash	< 2 mg/dl	Adult: < 500 ml/day Child: < 10 ml kg/day
1	Maculopapular rash < 25% BSA	2–3 mg/dl	Adult: 500–999 ml/day Child: 10–19.9 ml/kg/day or persistent nausea, vomiting, or anorexia, with a positive upper GI biopsy
2	Maculopapular rash 25–50% BSA	3.1–6 mg/dl	Adult: 1000–1500 ml/day Child: 20–30 ml/kg/day
3	Maculopapular rash > 50% BSA	6.1–15 mg/dl	Adult: >1500 ml/day Child: > 30 ml/kg/day
4	Generalized erythroderma with bullous formation	> 15 mg/dl	Severe abdominal pain with or without ileus

BSA = body surface area, GI = gastrointestinal, GVHD = graft versus host disease.

Overall Clinical Grade

Grade

0	No stage 1–4 of any organ
1	Stage 1–2 skin rash and no liver or GI involvement
2	Stage 3 skin rash, or Stage 1 liver involvement, or Stage 1 GI involvement
3	Stage 0–3 skin rash, with Stage 2-3 liver involvement, and/or Stage 2–3 GI involvement
4	Stage 4 skin rash, liver, and/or GI involvement