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Sci Rep. 2019 Apr 15;9(1):6083. doi: 10.1038/s41598-019-42652-6.

Dysbiosis patterns during re-induction/salvage versus induction chemotherapy for acute leukemia.

Author information

1
Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA. arashidi@umn.edu.
2
Department of Surgery, University of Minnesota, Minneapolis, MN, USA.
3
BioTechnology Institute, University of Minnesota, St. Paul, MN, USA.
4
Department of Biology, Macalester College, St. Paul, Minnesota, USA.
5
Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
6
Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
7
Department of Pharmacy, University of Minnesota Medical Center, Minneapolis, MN, USA.
8
Department of Microbiology and Immunology, University of Minnesota, Minneapolis, MN, USA.

Abstract

Acute leukemia (AL) patients undergoing intensive induction chemotherapy develop severe gut dysbiosis, placing them at heightened risk for infectious complications. Some AL patients will undergo "repeat therapy" (re-induction or salvage) due to persistent or relapsed disease. We hypothesized that prior injury to the microbiome during induction may influence dysbiosis patterns during repeat therapy. To test this hypothesis, we analyzed the bacterial microbiome profiles of thrice-weekly stool samples from 20 intensively treated AL patients (first induction: 13, repeat therapy: 7) by 16S rRNA sequencing. In mixed-effects modeling, repeat therapy was a significant predictor of Enterococcus expansion (P = 0.006), independently of antibiotic exposure, disease type, feeding mode, and week of chemotherapy. Bayesian analysis of longitudinal data demonstrated larger departures of microbial communities from the pre-chemotherapy baseline during repeat therapy compared to induction. This increased ecosystem instability during repeat therapy possibly impairs colonization resistance and increases vulnerability to Enterococcus outgrowth. Microbiota restoration therapies at the end of induction or before starting subsequent therapy warrant investigation.

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