Can Fecal Transplants Help Patients With Steroid-Resistant Acute Graft-Versus-Host Disease of the Gut?

In a pilot study published in Blood, Kazuhiko Kakihana, MD, PhD, of the Hematology Division at the Tokyo Metropolitan Cancer and Infectious Diseases Center in Komagome, Japan, and authors found that fecal microbiota transplant (FMT) may offer a novel therapeutic option for acute graft-versus-host disease (aGVHD) in patients with acute myeloid leukemia who undergo hematopoietic cell transplantation (HCT).

“FMT for HCT patients carries a potential risk of infection by infused microbiota because of [their] immunosuppressed status,” Dr. Kakihana and authors wrote. In this small study, the researchers evaluated the safety of FMT in four patients with steroid-resistant (n=3) or steroid-dependent (n=1) gut aGVHD. FMT donations were supplied by the patient’s spouse or a relative who passed the screening for transmissible diseases.

The first FMT was performed a median of 92 days after HCT (range = 60-174 days), and patients were evaluated 28 days after the final FMT or at the time of maximum response. No severe adverse events were observed and all patients responded, with three complete responses and one partial response.

The authors also observed an improvement in gastrointestinal symptoms within several days in the steroid-resistant cases. They noted that steroid dose could be successfully reduced by more than half (mean = 69% reduction) compared with that before FMT.

Source: Kakihana K, Fujioka Y, Suda W, et al. Fecal microbiota transplantation for patients with steroid-resistant/dependent acute graft-versus-host disease of the gut. Blood. 2016 July 26. [Epub ahead of print]