Clinical versus histological grading in the assessment of cutaneous graft versus host disease

Table 2 Histological grading system for acute and chronic cutaneous graft versus host disease

Histological grading of acute GvHD^a
Grade	Morphological criteria
0	Normal skin or epidermal changes due to other causes than GvHD
1	Vacuolar alteration of junction between epidermis and dermis
2	Grade 1 with dyskeratotic cells within the epidermis and/or hair follicle, infiltrate of lymphocytes within the dermis
3	Grade 2 with fusion of vacuoles to form clefts and microvesicles
4	Separation of epidermis from dermis

Histological grading chronic GvHD (proposed criteria focusing on sclerotic features only)^b
Grade	Criteria
Limited	Sclerosis within the superficial dermis, including coarsening of the fibers
Extensive	Sclerosis extending into the deep dermis or very dense sclerosis in any layer of the skin

^aAccording to Horn’s adapted criteria from Lerner [7]
^bIn histological grading, the lichenoid variant of chronic GvHD was graded according to the components in acute GvHD

ISSN: 2047-783X