Conditioning regimens are associated with distinct patterns of microbiota injury in allogeneic hematopoietic cell transplantation Journal Article


Authors: Shouval, R.; Waters, N. R.; Gomes, A. L. C.; Zuanelli Brambilla, C.; Fei, T.; Devlin, S. M.; Nguyen, C. L.; Markey, K. A.; Dai, A.; Slingerland, J. B.; Clurman, A. G.; Fontana, E.; Amoretti, L. A.; Wright, R. J.; Hohl, T. M.; Taur, Y.; Sung, A. D.; Weber, D.; Hashimoto, D.; Teshima, T.; Chao, N. J.; Holler, E.; Scordo, M.; Giralt, S. A.; Perales, M. A.; Peled, J. U.; van den Brink, M. R. M.
Article Title: Conditioning regimens are associated with distinct patterns of microbiota injury in allogeneic hematopoietic cell transplantation
Abstract: PURPOSE: The gut microbiota is subject to multiple insults in allogeneic hematopoietic cell transplantation (allo-HCT) recipients. We hypothesized that preparative conditioning regimens contribute to microbiota perturbation in allo-HCT. EXPERIMENTAL DESIGN: This was a retrospective study that evaluated the relationship between conditioning regimens exposure in 1,188 allo-HCT recipients and the gut microbiome. Stool samples collected from 20 days before transplantation up to 30 days after were profiled using 16S rRNA sequencing. Microbiota injury was quantified by changes in α-diversity. RESULTS: We identified distinct patterns of microbiota injury that varied by conditioning regimen. Diversity loss was graded into three levels of conditioning-associated microbiota injury (CMBI) in a multivariable model that included antibiotic exposures. High-intensity regimens, such as total body irradiation (TBI)-thiotepa-cyclophosphamide, were associated with the greatest injury (CMBI III). In contrast, the nonmyeloablative regimen fludarabine-cyclophosphamide with low-dose TBI (Flu/Cy/TBI200) had a low-grade injury (CMBI I). The risk of acute GVHD correlated with CMBI degree. Pretransplant microbial compositions were best preserved with Flu/Cy/TBI200, whereas other regimens were associated with loss of commensal bacteria and expansion of Enterococcus. CONCLUSIONS: Our findings support an interaction between conditioning at the regimen level and the extent of microbiota injury. ©2022 American Association for Cancer Research.
Keywords: retrospective studies; transplantation, homologous; cyclophosphamide; hematopoietic stem cell transplantation; retrospective study; graft versus host reaction; transplantation conditioning; graft vs host disease; rna 16s; allotransplantation; adverse event; microflora; microbiota; rna, ribosomal, 16s; humans; human
Journal Title: Clinical Cancer Research
Volume: 29
Issue: 1
ISSN: 1078-0432
Publisher: American Association for Cancer Research  
Date Published: 2023-01-01
Start Page: 165
End Page: 173
Language: English
DOI: 10.1158/1078-0432.Ccr-22-1254
PUBMED: 36322005
PROVIDER: scopus
PMCID: PMC9812902
DOI/URL:
Notes: The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PDF -- Corresponding author is MSK author: Jonathan U. Peled -- Source: Scopus
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MSK Authors
  1. Sergio Andres Giralt
    1065 Giralt
  2. Tobias Martin Hohl
    105 Hohl
  3. Miguel-Angel Perales
    937 Perales
  4. Ying Taur
    147 Taur
  5. Sean McCarthy Devlin
    612 Devlin
  6. Michael Scordo
    381 Scordo
  7. Jonathan U Peled
    158 Peled
  8. Emily Fontana
    31 Fontana
  9. Antonio LC Gomes
    47 Gomes
  10. Kate Ann Markey
    39 Markey
  11. Annelie G Clurman
    27 Clurman
  12. Roberta Justine Wright
    15 Wright
  13. Roni Shouval
    167 Shouval
  14. Anqi Dai
    27 Dai
  15. Chi Nguyen
    18 Nguyen
  16. Nicholas R. Waters
    13 Waters
  17. Teng Fei
    45 Fei