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Haematologica. 2019 Aug;104(8):1682-1688. doi: 10.3324/haematol.2018.198549. Epub 2019 Feb 7.

Fecal microbiota transplantation before or after allogeneic hematopoietic transplantation in patients with hematologic malignancies carrying multidrug-resistance bacteria.

Author information

1
Department of Hematology, Saint Antoine Hospital, Paris, France giorgia.battipaglia@aphp.fr.
2
Federico II University, Hematology Department, Naples, Italy.
3
Department of Hematology, Saint Antoine Hospital, Paris, France.
4
Sorbonne Universités, UPMC Univ Paris 06, INSERM, Centre de Recherche Saint-Antoine (CRSA), F-75012 Paris, France.
5
Service d'Hématologie, Hôpital Brabois, CHRU Nancy, France.
6
CMRS UMR 7563, IMoPa, Biopole de l'Université de Lorraine, France.
7
Microbiote Transplant Préparations Unit, Pharmacy Department, Saint Antoine Hospital, Paris, France.
8
Unité d'Hygiène et de Lutte Contre les Infections Nosocomiales, Saint Antoine Hospital, Paris, France.
9
Department of Bacteriology, Saint Antoine Hospital, Paris, France.
10
Department of Gastroenterology, Saint Antoine Hospital, AP-HP, Paris, France.
11
Sorbonne Université, École Normale Supérieure, PSL Research University, CNRS, INSERM, AP-HP, Hôpital Saint-Antoine, Laboratoire de Biomolécules, LBM, F-75005 Paris, France.
12
INRA, UMR1319 Micalis & AgroParisTech, Jouy en Josas, France.

Abstract

Fecal microbiota transplantation is an effective treatment in recurrent Clostridium difficile infection. Promising results to eradicate multidrug-resistant bacteria have also been reported with this procedure, but there are safety concerns in immunocompromised patients. We report results in ten adult patients colonized with multidrug-resistant bacteria, undergoing fecal microbiota transplantation before (n=4) or after (n=6) allogeneic hematopoietic stem cell transplantation for hematologic malignancies. were obtained from healthy related or unrelated donors. Fecal material was delivered either by enema or via nasogastric tube. Patients were colonized or had infections from either carbapenemase-producing bacteria (n=8) or vancomycin-resistant enterococci (n=2). Median age at fecal microbiota transplantation was 48 (range, 16-64) years. Three patients needed a second transplant from the same donor due to initial failure of the procedure. With a median follow up of 13 (range, 4-40) months, decolonization was achieved in seven of ten patients. In all patients, fecal micro-biota transplantation was safe: one patient presented with constipation during the first five days after FMT and two patients had grade I diarrhea. One case of gut grade III acute graft-versus-host disease occurred after fecal microbiota transplantation. In patients carrying or infected by multidrug-resistant bacteria, fecal microbiota transplantation is an effective and safe decolonization strategy, even in those with hematologic malignancies undergoing hematopoietic stem cell transplantation.

PMID:
30733264
DOI:
10.3324/haematol.2018.198549
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