Ancillary Therapy and Supportive Care of Chronic Graft-versus-Host Disease: National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: V. Ancillary Therapy and Supportive Care Working Group Report

Abstract

The Ancillary Therapy and Supportive Care Working Group had 3 goals: (1) to establish guidelines for ancillary therapy and supportive care in chronic graft-versus-host disease (GVHD), including treatment for symptoms and recommendations for patient education, preventive measures, and appropriate follow-up; (2) to provide guidelines for the prevention and management of infections and other common complications of treatment for chronic GVHD; and (3) to highlight the areas with the greatest need for clinical research. The definition of "ancillary therapy and supportive care" embraces the most frequent immunosuppressive or anti-inflammatory interventions used with topical intent and any other interventions directed at organ-specific control of symptoms or complications resulting from GVHD and its therapy. Also included in the definition are educational, preventive, and psychosocial interventions with this same objective. Recommendations are organized according to the strength and quality of evidence supporting them and cover the most commonly involved organs, including the skin, mouth, female genital tract, eyes, gastrointestinal tract, and lungs. Recommendations are provided for prevention of infections, osteoporosis, and steroid myopathy and management of neurocognitive and psychosocial adverse effects related to chronic GVHD. Optimal care of patients with chronic GVHD often requires a multidisciplinary approach.

Unrelated cord blood transplantation for thalassaemia: a single-institution experience of 35 patients

“…Autoimmune cytopenias are a recognized complication after HSCT, and are considered to be a feature of chronic GVHD when another symptom of chronic GVHD is present. 19,20 O'Brien et al 21 described the largest series of paediatric patients who received unrelated donor HSCT with 19 (6%) of 303 patients developing autoimmue haemolytic anaemia. It was proposed that HLA mismatches may have been a risk factor, in addition to the T-cell depletion process.…”

Optimal management of chronic graft‐versus‐host disease in children

“…Because chronic GVHD patients are on long-term corticosteroids, they are especially at risk for osteoporosis. It is recommended that calcium and vitamin D levels should be obtained at least yearly in patients with chronic GVHD and that replacement, to prevent osteoporosis, be initiated in deficient states (Schimmer et al, 2000;Couriel et al, 2006). Patients with chronic GVHD should also be evaluated with bone mineral density (BMD) measurements using dual-enery X-ray absorptiometric (DEXA) scans.…”

Health-related quality of life in pediatric patients after allogeneic SCT: development of the PedsQL Stem Cell Transplant module and results of a pilot study

“…In 2010 and 2011, 35 SCT patients with a mean age of 10.5 (range, [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] years were included in the process of testing the new instrument. These patients and their parents were not identical to those who participated in the developmental process (see above).…”