MAGIC Acute GVHD Staging and Grading
MAGIC acute GVHD staging and grading (Harris and colleagues, BBMT 2016), the consortium standard that superseded the Modified Glucksberg grade for data collection and is the grading used in the ruxolitinib registration trials.
Open the calculator → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.
Example
- Skin stage, ACTIVE ERYTHEMA ONLY
- 3
- Liver stage by bilirubin
- 0
- Upper GI stage
- 0
- Lower GI stage
- 0
Result: Grade II
The tool opens with these values already filled in. Replace them with your own.
What the result means
- NOT a maximum
- Stage-3 skin alone is grade II, but stage-2 lower GI alone is grade III. Pattern rules, not an aggregate.
- Skin
- 0-4 by active erythema. Stage 4 is a CONJUNCTION: >50% BSA PLUS bullae PLUS >5% desquamation.
- Liver
- 0-4 by bilirubin: <2, 2-3, 3.1-6, 6.1-15, >15 mg/dL.
- Upper GI
- ONLY 0 or 1 exist. No stage 2, 3 or 4, and it can never by itself drive grade III or IV.
- Lower GI
- 0-4. Stage 4 is QUALITATIVE (pain/ileus or bloody stool) and overrides volume.
- Grade I
- Stage 1-2 skin with no liver, upper GI or lower GI involvement.
- Grade II
- Stage 3 rash, or stage 1 liver, upper GI or lower GI.
- Grade III
- Stage 2-3 liver or lower GI, with skin 0-3 and upper GI 0-1.
- Grade IV
- Stage 4 skin, liver or lower GI, with upper GI 0-1.
- Scope
- Stages an established diagnosis. Does not diagnose GVHD or distinguish its mimics.
What you enter
- Skin stage, ACTIVE ERYTHEMA ONLY
- Liver stage by bilirubin
- Upper GI stage.
- Lower GI stage.
Full field descriptions
- Skin stage, ACTIVE ERYTHEMA ONLY [0 = No active (erythematous) GVHD rash; 1 = Maculopapular rash under 25 percent of body surface area; 2 = Maculopapular rash 25 to 50 percent of body surface area; 3 = Maculopapular rash over 50 percent of body surface area; 4 = Generalized erythroderma over 50 percent BSA PLUS bullous formation PLUS desquamation over 5 percent BSA. All three are required.]
- Liver stage by bilirubin [0 = Bilirubin under 2 mg/dL; 1 = Bilirubin 2 to 3 mg/dL; 2 = Bilirubin 3.1 to 6 mg/dL; 3 = Bilirubin 6.1 to 15 mg/dL; 4 = Bilirubin over 15 mg/dL]
- Upper GI stage. ONLY 0 OR 1 EXIST - there is no upper-GI stage 2, 3 or 4 [0 = No or intermittent nausea, vomiting or anorexia; 1 = Persistent nausea, vomiting or anorexia]
- Lower GI stage. Stage 4 is QUALITATIVE and overrides volume [0 = Adult: under 500 mL/day or under 3 episodes/day. Child: under 10 mL/kg/day or under 4 episodes/day.; 1 = Adult: 500 to 999 mL/day or 3 to 4 episodes/day. Child: 10 to 19.9 mL/kg/day or 4 to 6 episodes/day.; 2 = Adult: 1000 to 1500 mL/day or 5 to 7 episodes/day. Child: 20 to 30 mL/kg/day or 7 to 10 episodes/day.; 3 = Adult: over 1500 mL/day or over 7 episodes/day. Child: over 30 mL/kg/day or over 10 episodes/day.; 4 = Severe abdominal pain with or without ileus, OR grossly bloody stool, REGARDLESS OF STOOL VOLUME.]
How this is calculated
Harris AC, Young R, Devine S, et al. International, Multicenter Standardization of Acute Graft-versus-Host Disease Clinical Data Collection: A Report from the Mount Sinai Acute GVHD International Consortium. Biol Blood Marrow Transplant. 2016;22(1):4-10. Read the source ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.