The Role of Fecal Microbiota Transplantation in the Allogeneic Stem Cell Transplant Setting

Abstract

Microbiota changes during allogeneic hematopoietic stem cell transplantation has several known causes: conditioning chemotherapy and radiation, broad-spectrum antibiotic administration, modification in nutrition status and diet, and graft-versus-host disease. This article aims to review the current knowledge about the close link between microbiota and allogeneic stem cell transplantation setting. The PubMed search engine was used to perform this review. We analyzed data on microbiota dysbiosis related to the above-mentioned affecting factors. We also looked at treatments aimed at modifying gut dysbiosis and applications of fecal microbiota transplantation in the allogeneic stem cell transplant field, with particular interest in fecal microbiota transplantation for graft-versus-host disease (GvHD), multidrug-resistant and clostridium difficile infections, and microbiota restoration after chemotherapy and antibiotic therapy.

Alteration of Gut Microbiota Composition and Diversity in Acute and/or Chronic Graft-versus-Host Disease Following Hematopoietic Stem Cell Transplantation: A Prospective Cohort Study

“…Although high-dose glucocorticoids are typically harnessed as first-line treatment for GvHD, the high failure rate, approaching 60% in patients with grade IV disease [ 14 ], necessitates the development of new targeted therapies [ 15 ]. The treatment armamentarium of GvHD has expanded over the past few years, with clinical trials currently underway to assess the effectiveness and safety of new regimens [ 16 , 17 ]. Fecal microbiota transplantation has also been studied for the treatment of GvHD, given the pivotal role of the gut microbiome in the pathogenesis of the disease [ 18 ].…”

Next-Generation Sequencing-Based Monitoring of Intestinal Bacteria and Bacteriophages Following Fecal Microbiota Transplantation in Inflammatory Bowel Diseases

“…Several clinical studies on FMT efficiency in steroid-resistant GVHD were recently discussed demonstrating complete clinical response in 40% of cases, with rare infectious complications [31]. When summarizing results from small clinical studies, the post-FMT samples show partial restoration of gut microbiota composition, in particular, Ruminococcaceae, Lachnospiraceae, Bacteroidaceae, Streptococcaceae, and Lactobacillaceae [32]. In our experience, clinical response in refractory GVHD is associated with increased contents of Bacteroides fragilis and Faecalibacterium prausnitzii in fecal samples at 2-4 weeks after FMT [33].…”