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Ferrata Storti Foundation
Haematologica 2019 Volume 104(8):1682-1688
Stem Cell Transplantation
Fecal microbiota transplantation before or after allogeneic hematopoietic transplantation in patients with hematologic malignancies carrying multidrug-resistance bacteria
Giorgia Battipaglia,1,2 Florent Malard,1,3 Marie Therèse Rubio,1,4,5
Annalisa Ruggeri,1 Anne Claire Mamez,1 Eolia Brissot,1,3 Federica Giannotti,1 Remy Dulery,1 Anne Christine Joly,6 Minh Tam Baylatry,6
Marie Jeanne Kossmann,7 Jacques Tankovic,8 Laurent Beaugerie,6,9
Harry Sokol and 3,9,10,11* Mohamad Mohty1,3*
1Department of Hematology, Saint Antoine Hospital, Paris, France; 2Federico II University, Hematology Department, Naples, Italy; 3Sorbonne Universités, UPMC Univ Paris 06, INSERM, Centre de Recherche Saint-Antoine (CRSA), F-75012 Paris, France; 4Service d’Hématologie, Hôpital Brabois, CHRU Nancy, France; 5CMRS UMR 7563, IMoPa, Biopole de l’Université de Lorraine, France; 6Microbiote Transplant Préparations Unit, Pharmacy Department, Saint Antoine Hospital, Paris, France; 7Unité d’Hygiène et de Lutte Contre les Infections Nosocomiales, Saint Antoine Hospital, Paris, France; 8Department of Bacteriology, Saint Antoine Hospital, Paris, France; 9Department of Gastroenterology, Saint Antoine Hospital, AP-HP, Paris, France; 10Sorbonne Université, École Normale Supérieure, PSL Research University, CNRS, INSERM, AP-HP, Hôpital Saint-Antoine, Laboratoire de Biomolécules, LBM, F-75005 Paris, France and 11INRA, UMR1319 Micalis & AgroParisTech, Jouy en Josas, France
ABSTRACT
Fecal microbiota transplantation is an effective treatment in recurrent Clostridium difficile infection. Promising results to eradicate multidrug- resistant bacteria have also been reported with this procedure, but there are safety concerns in immunocompromised patients. We report results in ten adult patients colonized with multidrug-resistant bacteria, undergoing fecal microbiota transplantation before (n=4) or after (n=6) allo- geneic hematopoietic stem cell transplantation for hematologic malignan- cies. Stools were obtained from healthy related or unrelated donors. Fecal material was delivered either by enema or via nasogastric tube. Patients were colonized or had infections from either carbapenemase-producing bacteria (n=8) or vancomycin-resistant enterococci (n=2). Median age at fecal microbiota transplantation was 48 (range, 16-64) years. Three patients needed a second transplant from the same donor due to initial failure of the procedure. With a median follow up of 13 (range, 4-40) months, decolo- nization was achieved in seven of ten patients. In all patients, fecal micro- biota transplantation was safe: one patient presented with constipation dur- ing the first five days after FMT and two patients had grade I diarrhea. One case of gut grade III acute graft-versus-host disease occurred after fecal microbiota transplantation. In patients carrying or infected by multidrug- resistant bacteria, fecal microbiota transplantation is an effective and safe decolonization strategy, even in those with hematologic malignancies undergoing hematopoietic stem cell transplantation.
Introduction
During the last decades, the prevalence of multidrug-resistant bacteria (MDRB) has largely increased, becoming a serious worldwide problem.1 Under physiological conditions, commensal microbiota prevents gut colonization from MDRB. However, in particular conditions, such as in patients with hematologic malignan- cies, use of chemotherapeutic agents and broad spectrum antibiotics may favor selection of resistant pathogens through the alterations of the gastrointestinal bar- rier and the consequent dysbiosis.2 Patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT) are at even higher risk of dysbiosis due to
*These authors contributed equally to this work as co-senior authors
Correspondence:
GIORGIA BATTIPAGLIA
giorgia.battipaglia@aphp.fr
Received: May 29, 2018. Accepted: January 31, 2019. Pre-published: February 7, 2019.
doi:10.3324/haematol.2018.198549
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