Abstract: |
Hematopoietic cell transplantation (HCT) is a critical treatment of patients with high-risk hematopoieticmalignancies, hematological deficiencies, and other immune diseases. In allogeneic HCT (allo-HCT), donor-derived T cells recognize host tissues as foreign, causing graft-versus-host disease (GVHD) whichis amaincontributor to morbidity and mortality. The intestine is one of the organs most severely affected by GVHD and research has recently highlighted the importance of bacteria, particularly the gut microbiota, in HCT outcome and in GVHD development. Loss of intestinal bacterial diversity is common during the course of HCT and is associated with GVHD development and treatment with broad-spectrum antibiotics. Loss of intestinal diversity and outgrowth of opportunistic pathogens belonging to the phylum Proteobacteria and Enterococcus genus have also been linked to increased treatment-related mortality including GVHD, infections, and organ failure after allo-HCT. Experimental studies in allo- HCT animal models have shown some promising results for prebiotic and probiotic strategies as prophylaxisor treatment of GVHD. Continuous research will be important todefine the relation of cause and effect for theseassociationsbetweenmicrobiota features and HCT outcomes. Importantly, studies focused on geographic and cultural differences in intestinal microbiota are necessary to define applicability of new strategies targeting the intestinalmicrobiota. © 2017 by The American Society of Hematology. |