Department of Internal Medicine and Center of Hematopoietic stem cell transplantation, Chungnam National University Hospital, Daejeon, South Korea.
Center of Hematopoietic stem cell transplantation, Chungnam National University Hospital, Daejeon, South Korea.
Hematology. 2021 Dec;26(1):96-102. doi: 10.1080/16078454.2021.1872957.
Changes in fecal microbiota affect the incidence and extent of graft-versus-host disease (GVHD) after allogeneic hematopoietic stem cell transplantation (HSCT). Most patients with hematological malignancies receive antibiotics for the treatment of febrile neutropenia prior to allogeneic HSCT, and pre-transplant use of antibiotics may influence the fecal microbiota and GVHD.
We retrospectively analysed consecutive adult patients with hematological malignancies who received allogeneic HSCT at Chungnam National University Hospital between 2007 and 2018. Pre-transplant use of antibiotics was defined as the use of antibiotics before conditioning chemotherapy.
This study included 131 patients with a median age of 46 (range, 18-71) years: 76 (58%) patients were AML, 28 (21.4%) with ALL, 23 (17.6%) with MDS, and 4 (3.1%) with CML. All patients received calcineurin inhibitors with short-course methotrexate for GVHD prophylaxis. A total of 31 (23.7%) patients received anti-thymocyte globulin. All patients received antibiotics prior to HSCT: 70 (53.4%) patients received glycopeptide, 114 (87.0%) received cefepime, 87 (66.4%) received piperacillin/tazobactam, and 51 (38.9%) received carbapenem. Patients who received glycopeptide had more frequently extensive chronic GVHD (cGVHD) than those who did not (51.1% vs. 28.1% at 5 years) and had more frequently cGVHD of the lung (34.8% vs. 15.8% at 5 years). Pre-transplant use of glycopeptide did not affect the overall survival (OS) or GVHD- and relapse-free survival (GRFS) (median OS; 49 months in glycopeptide group vs. not reached in non-glycopeptide group, =0.475; median GRFS; 9 months in glycopeptide group vs. 16 months in non-glycopeptide group, =0.092).
Pre-transplant use of glycopeptide tends to increase the incidence of extensive cGVHD.
粪便微生物群的变化会影响异基因造血干细胞移植（HSCT）后移植物抗宿主病（GVHD）的发生率和程度。大多数血液系统恶性肿瘤患者在接受异基因 HSCT 前因发热性中性粒细胞减少症接受抗生素治疗，移植前使用抗生素可能会影响粪便微生物群和 GVHD。
我们回顾性分析了 2007 年至 2018 年期间在忠南大学医院接受异基因 HSCT 的连续成年血液系统恶性肿瘤患者。移植前使用抗生素定义为在预处理化疗前使用抗生素。
这项研究包括 131 例中位年龄为 46 岁（范围 18-71 岁）的患者：76 例（58%）为 AML，28 例（21.4%）为 ALL，23 例（17.6%）为 MDS，4 例（3.1%）为 CML。所有患者均接受钙调神经磷酸酶抑制剂联合短程甲氨蝶呤预防 GVHD。共有 31 例（23.7%）患者接受抗胸腺细胞球蛋白治疗。所有患者在 HSCT 前均接受抗生素治疗：70 例（53.4%）患者接受糖肽，114 例（87.0%）患者接受头孢吡肟，87 例（66.4%）患者接受哌拉西林/他唑巴坦，51 例（38.9%）患者接受碳青霉烯类抗生素。接受糖肽治疗的患者比未接受糖肽治疗的患者更常发生广泛慢性 GVHD（5 年时分别为 51.1%和 28.1%），且更常发生肺部 GVHD（5 年时分别为 34.8%和 15.8%）。移植前使用糖肽并不影响总生存（OS）或 GVHD 和复发无事件生存（GRFS）（糖肽组中位 OS：49 个月 vs. 非糖肽组未达到，=0.475；糖肽组中位 GRFS：9 个月 vs. 非糖肽组 16 个月，=0.092）。
移植前使用糖肽可能会增加广泛慢性 GVHD 的发生率。
