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Fecal microbiota transplant effective for GVHD after stem cell transplantation
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Fecal microbiota transplantation effectively treated acute graft-versus-host-disease of the gut in patients who underwent stem cell transplantation, according to data from a pilot study.
“Although allogeneic stem cell transplantation is a curative treatment for various hematological diseases, acute graft-versus-host disease (GVHD) represents a major cause of morbidity and mortality,” Kazuhiko Kakihana, MD, PhD, of the hematology division at Tokyo Metropolitan Cancer and Infectious Diseases Center at Komagome Hospital, and colleagues wrote. “Glucocorticoids are used as the first-line therapy for acute GVHD, but only about half of patients respond and no second-line treatment has yet been established.”
Four patients who developed acute GVHD after stem cell transplantation for acute myeloid leukemia underwent fecal microbiota transplantation. Three patients had steroid-resistant acute GVHD and one had steroid-dependent acute GVHD.
Patients’ spouses and relatives who had passed screening for transmittable diseases donated fecal suspensions with a median volume of 180 mL to 230 mL. The researchers then administered the first of two rounds of suspensions a median of 92 days after stem cell transplantation.
Investigators monitored the progression of adverse effects in the week following each infusion, then evaluated responses 28 days after treatment initiation.
Each patient received the first round of fecal microbiota transplantation while being treated with methylprednisolone, and they were experiencing infectious complications at the time of the first transplant.
Fecal microbiota transplantation appeared effective for all four patients, Kakihana and colleagues wrote. Three patients achieved a complete response and one had a partial response. Patients with steroid-resistant cases experienced improvement in gastrointestinal symptoms within several days of treatment.
One patient developed a fever and experienced a recurrence of acute GVHD after researchers administered reduced amounts of methylprednisolone and tacrolimus. Researchers noted, however, that the patient’s feces were dominated by Escherichia bacteria, which had previously been correlated with GVHD in mice.
“Fecal microbiota transplantation was safely performed in stem cell transplant patients and offers promise as a potential treatment option for acute GVHD,” Kakihana and colleagues wrote. “Further evaluation to confirm the safety and efficacy of fecal microbiota transplantation for acute GVHD is warranted. Despite the very small number of patients, our results are highly suggestive for elucidating the associations between microbiota and human immunity.” – by Andy Polhamus
Disclosure: The researchers report no relevant financial disclosures.
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