Abstract
Post-transplant microbial diversity in the gastrointestinal tract is closely associated with clinical outcomes following allogeneic hematopoietic stem cell transplantation (allo-HSCT). However, little is known about the impact of the fecal microbiota before allo-HSCT. We analyzed fecal samples approximately 2 weeks before conditioning among 107 allo-HSCT recipients between 2013 and 2015. Microbial analysis was performed using 16S rRNA gene sequencing. Operational taxonomic unit-based microbial diversity was estimated by calculating the Shannon index. Patients were classified into three groups based on the diversity index: low (<2), intermediate (2, 3), and high (>3) diversity (18 (16.8%), 48 (44.9%), and 41 (38.3%) patients, respectively). There were no significant differences in the 20-month overall survival, cumulative incidence of relapse, and non-relapse mortality among three groups. The cumulative incidence of grade II to IV acute graft-versus-host disease (aGVHD) was similar among the three groups (low 55.6%; intermediate 35.4%; high 48.8%, p = 0.339, at day 100). Furthermore, we found no differences in the cumulative incidence of grade II to IV acute gastrointestinal GVHD among the three groups (low 38.9%; intermediate 21.3%; high 24.4%, p = 0.778, at day 100). Regarding the composition of microbiota before allo-HSCT, aGVHD patients showed a significantly higher abundance of phylum Firmicutes (p < 0.01) and a lower tendency for Bacteroidetes (p = 0.106) than non-aGVHD patients. Maintenance of Bacteroidetes throughout allo-HSCT may be a strategy to prevent aGVHD.
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We are very grateful to the patients in the current study and would like to thank the nursing staff at our institution.
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N.D., H.M., H.N., M.H., E.S., N.T., H.S., K.H., and K.O. designed this study. N.D., M.S., S.S., A.I., Y.S., Y.N., K.I, K.Y., T.K., and K.K. collected samples. S.S., J.O., I.M., H.M., Y.F., D.S., W.S., K.T., and K.A. extracted DNA and analyzed fecal samples. N.D. wrote the manuscript.
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This study was approved by the Ethics Committee of Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital.
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The authors declare that they have no conflict of interest.
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Informed consent was obtained from all patients prior to being included in the study.
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Doki, N., Suyama, M., Sasajima, S. et al. Clinical impact of pre-transplant gut microbial diversity on outcomes of allogeneic hematopoietic stem cell transplantation. Ann Hematol 96, 1517–1523 (2017). https://doi.org/10.1007/s00277-017-3069-8
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DOI: https://doi.org/10.1007/s00277-017-3069-8