The gut microbiome can be adversely affected by chemotherapy and antibiotics prior to hematopoietic cell transplantation (HCT). This affects graft success and increases susceptibility to multidrug-resistant organism (MDRO) colonization and infection. We performed an initial retrospective analysis of our use of fecal microbiota transplantation (FMT) from healthy donors as therapy for MDRO-colonized patients with hematological malignancy. FMT was performed on eight MDRO-colonized patients pre-HCT (FMT-MDRO group), and outcomes compared with 11 MDRO colonized HCT patients from the same period. At 12 months, survival was significantly higher in the FMT-MDRO group (70% 36% = 0.044). Post-HCT, fewer FMT-MDRO patients required intensive care (0% 46%, = 0.045) or experienced fever (0.29 0.11 days, = 0.027). Intestinal MDRO decolonization occurred in 25% of FMT-MDRO patients 11% non-FMT MDRO patients. Despite the significant differences and statistically comparable patient/transplant characteristics, as the sample size was small, a matched-pair analysis between both groups to non-MDRO colonized control cohorts (2:1 matching) was performed. At 12 months, the MDRO group who did not have an FMT had significantly lower survival (36.4% 61.9% respectively, =0.012), and higher non relapse mortality (NRM; 60.2% 16.7% respectively, =0.009) than their paired non-MDRO-colonized cohort. Conversely, there was no difference in survival (70% 43.4%, =0.14) or NRM (12.5% 31.2% respectively, =0.24) between the FMT-MDRO group and their paired non-MDRO cohort. Collectively, these data suggest that negative clinical outcomes, including mortality associated with MDRO colonization, may be ameliorated by pre-HCT FMT, even in the absence of intestinal MDRO decolonization. Further work is needed to explore this observed benefit.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8430254PMC
http://dx.doi.org/10.3389/fcimb.2021.684659DOI Listing

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The gut microbiome can be adversely affected by chemotherapy and antibiotics prior to hematopoietic cell transplantation (HCT). This affects graft success and increases susceptibility to multidrug-resistant organism (MDRO) colonization and infection. We performed an initial retrospective analysis of our use of fecal microbiota transplantation (FMT) from healthy donors as therapy for MDRO-colonized patients with hematological malignancy.

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