Fecal Microbiota Transplant for Hematologic and Oncologic Diseases: Principle and Practice

Abstract

Understanding of the importance of the normal intestinal microbial community in regulating microbial homeostasis, host metabolism, adaptive immune responses, and gut barrier functions has opened up the possibility of manipulating the microbial composition to modulate the activity of various intestinal and systemic diseases using fecal microbiota transplant (FMT). It is therefore not surprising that use of FMT, especially for treating relapsed/refractory Clostridioides difficile infections (CDI), has increased over the last decade. Due to the complexity associated with and treatment for these diseases, patients with hematologic and oncologic diseases are particularly susceptible to complications related to altered intestinal microbial composition. Therefore, they are an ideal population for exploring FMT as a therapeutic approach. However, there are inherent factors presenting as obstacles for the use of FMT in these patients. In this review paper, we discussed the principles and biologic effects of FMT, examined the factors rendering patients with hematologic and oncologic conditions to increased risks for relapsed/refractory CDI, explored ongoing FMT studies, and proposed novel uses for FMT in these groups of patients. Finally, we also addressed the challenges of applying FMT to these groups of patients and proposed ways to overcome these challenges.

Intestinal barrier functions in hematologic and oncologic diseases

“…In addition to restoring the balance of microbial community in the intestine, it provides a mean to replenish the microbial community with SCFA producers to fortify the intestinal barrier. FMT may be therapeutically beneficial to patients with various hematologic and oncologic diseases [123]. In addition to treating malignancy-associated recurrent/refractory C. diff.…”

Emerging role of human microbiome in cancer development and response to therapy: special focus on intestinal microflora

“…With respect to other approaches (applying probiotics and prebiotic components), fecal microbiota transplantation is worked quicker and is more effective in the reconstitution of the intestinal microflora [ 172 ]. Moreover, FMT showed more success in controlling Clostridium difficile infection because feces contain additional metabolites such as proteins, bacteriophages, and bile acids [ 173 ].…”

Local Breast Microbiota: A “New” Player on the Block

“…Faecal microbiota transplant (FMT) is an emerging therapeutic approach in many potential applications and has primarily been applied in patients with relapsed/refractory Clostridioides difficile infection. Due to the complexity of the diseases and their treatment, patients with haematologic and oncologic diseases are particularly susceptible to complications related to altered intestinal microbiota [ 28 ]. Currently, there are nearly 40 studies registered that primarily evaluate the safety of FMT, the use of FMT following allogeneic hematopoietic stem cell transplantation, improvement in ICI response, and the treatment of the complications that arise due to cancer therapy [ 28 ].…”

“…Due to the complexity of the diseases and their treatment, patients with haematologic and oncologic diseases are particularly susceptible to complications related to altered intestinal microbiota [ 28 ]. Currently, there are nearly 40 studies registered that primarily evaluate the safety of FMT, the use of FMT following allogeneic hematopoietic stem cell transplantation, improvement in ICI response, and the treatment of the complications that arise due to cancer therapy [ 28 ]. Various retrospective studies suggested a possible relation between broad-spectrum antibiotics, altered intestinal microbiota and its negative impact on responses to ICI treatment in cancer patients [ 29 , 30 , 31 , 32 ].…”