Fecal microbiota transplantation in capsules for the treatment of steroid refractory and steroid dependent acute graft vs. host disease: a pilot study.

Autor: Youngster I; Shamir Medical Center, Beer Yaacov, Israel.; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel., Eshel A; Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel., Geva M; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.; Hematology and Bone Marrow Transplantation Division, Chaim Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel., Danylesko I; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.; Hematology and Bone Marrow Transplantation Division, Chaim Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel., Henig I; Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel., Zuckerman T; Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel.; Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel., Fried S; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.; Hematology and Bone Marrow Transplantation Division, Chaim Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel., Yerushalmi R; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.; Hematology and Bone Marrow Transplantation Division, Chaim Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel., Shem-Tov N; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.; Hematology and Bone Marrow Transplantation Division, Chaim Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel., Fein JA; Department of Medicine, Weill Cornell Medical College, New York, NY, USA., Bomze D; Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.; Division of Dermatology, Sourasky Medical Center, Tel Aviv, Israel., Shimoni A; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.; Hematology and Bone Marrow Transplantation Division, Chaim Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel., Koren O; Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel., Shouval R; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. shouvalr@mskcc.org.; Hematology and Bone Marrow Transplantation Division, Chaim Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel. shouvalr@mskcc.org.; Adult BMT Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA. shouvalr@mskcc.org.; Weill Cornell Medical College, New York, NY, USA. shouvalr@mskcc.org., Nagler A; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.; Hematology and Bone Marrow Transplantation Division, Chaim Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel.
Jazyk: angličtina
Zdroj: Bone marrow transplantation [Bone Marrow Transplant] 2024 Mar; Vol. 59 (3), pp. 409-416. Date of Electronic Publication: 2024 Jan 11.
DOI: 10.1038/s41409-024-02198-2
Abstrakt: Acute graft-versus-host disease (aGvHD) is a serious complication of allogeneic hematopoietic stem-cell transplantation with limited treatment options. The gut microbiome plays a critical role in aGvHD pathogenesis. Fecal microbiota transplantation (FMT) has emerged as a potential therapeutic approach to restore gut microbial diversity. In this prospective pilot study, 21 patients with steroid-resistant or steroid-dependent lower gastrointestinal aGvHD received FMT in capsule form. At 28 days after the first FMT, the overall response rate was 52.4%, with 23.8% complete and 28.6% partial responses. However, sustained responses were infrequent, with only one patient remaining aGvHD-free long-term. FMT was generally well-tolerated. Microbiome analysis revealed dysbiosis in pre-FMT patient stool samples, with distinct microbial characteristics compared to donors. Following FMT, there was an increase in beneficial Clostridiales and a decrease in pathogenic Enterobacteriales. These findings highlight the potential of FMT as a treatment option for steroid-resistant aGvHD. Trial registration number NCT #03214289.
(© 2024. The Author(s), under exclusive licence to Springer Nature Limited.)
Databáze: MEDLINE
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