National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: V. The 2014 Ancillary Therapy and Supportive Care Working Group Report

Abstract

The 2006 National Institutes of Health (NIH) Consensus paper presented recommendations by the Ancillary Therapy and Supportive Care Working Group to support clinical research trials in chronic graft-versus-host disease (GVHD). Topics covered in that inaugural effort included the prevention and management of infections and common complications of chronic GVHD, as well as recommendations for patient education and appropriate follow-up. Given the new literature that has emerged during the past 8 years, we made further organ-specific refinements to these guidelines. Minimum frequencies are suggested for monitoring key parameters relevant to chronic GVHD during systemic immunosuppressive therapy and, thereafter, referral to existing late effects consensus guidelines is advised. Using the framework of the prior consensus, the 2014 NIH recommendations are organized by organ or other relevant systems and graded according to the strength and quality of supporting evidence.

Mechanistic approaches for the prevention and treatment of chronic GVHD

“…To this day, corticosteroids and meticulous organ-specific care remain the mainstay of therapy. 3,4 Corticosteroids are profoundly anti-inflammatory and broadly immune suppressive, affecting both innate and adaptive immunity. The addition of a calcineurin inhibitor to corticosteroids does not increase the response rate, but it allows for a reduction in steroid dosing that can reduce the sequelae of chronic corticosteroid therapy.…”

Bone Mineral Turnover after Allogeneic Hematopoietic Stem Cell Transplantation in Children: A Single Center Cohort Study

“…Одной из целей лечения аваскулярных некрозов являет-ся облегчение боли (с помощью фармакологических или хирургических подходов). На ранней стадии заболевания пациентам рекомендуется использовать костыли, что-бы избежать нагрузки на конечности [13,36]. Лечение поздних стадий -хирургическое, включает в себя декомпрессию пораженного участка и замену сустава (например, различные способы протезирования).…”

What do we need to know about allogeneic hematopoietic stem cell transplant survivors?

“…Formation begins to appear usually within 3-5 years, and the incidence following fractionated TBI appears to be between 40 and 70%. 2,10,21,22 Dry eye syndrome occurs in 40-75% of allo-HSCT recipients, and may be the heralding symptom of ocular GvHD. 23 Secondary complications include conjunctival keratitis, corneal keratinization, ulceration and perforation of the cornea.…”