Ancillary and supportive care in chronic graft-versus-host disease

Chronic graft-versus-host disease (GVHD) continues to be the most important long-term complication of allogeneic HSCT. Responses to immunomodulation are often partial, and patients continue to experience reflares of the disease and symptoms that can significantly impair quality of life. 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. This chapter will focus on ancillary and supportive care for the most frequent manifestations of chronic GVHD, including skin and appendages, eyes, oral mucosa, vagina, and immunologic and infectious complications. The level of recommendation of all interventions is based on an evidence-based system developed by the National Institutes of Health (NIH) Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-Versus-Host Disease.