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粪便微生物群移植治疗移植物抗宿主病的安全性和有效性。

Safety and efficacy of fecal microbiota transplantation in the treatment of graft-versus-host disease.

作者信息

Qiao Xiaoying, Biliński Jarosław, Wang Leyi, Yang Tianyu, Luo Rongmu, Fu Yi, Yang Guibin

机构信息

Peking University Health Science Center, Beijing, 100191, China.

Peking University People'hospital, Beijing, China.

出版信息

Bone Marrow Transplant. 2023 Jan;58(1):10-19. doi: 10.1038/s41409-022-01824-1. Epub 2022 Sep 27.

Abstract

This article evaluates the efficacy and safety of FMT in the treatment of GVHD after HSCT using a systematic literature search to conduct a meta-analysis constructed of studies involving GVHD patients treated with FMT. 23 studies were included, among which 2 prospective cohort studies, 10 prospective single arm studies, 2 retrospective single arm studies, 2 case series and 7 case reports, comprise a total of 242 patients with steroid-resistant or steroid-dependent GVHD secondary to HSCT who were treated with FMT. 100 cases achieved complete responses, while 61 cases showed partial responses, and 81 cases presented no effect after FMT treatment. The estimate of clinical remission odds ratio was 5.51 (95% CI 1.49-20.35) in cohort studies, and the pooled clinical remission rate is 64% (51-77%) in prospective single arm studies and 81% (62-95%) in retrospective studies, case series and case reports. Five (2.1%) patients had FMT-related infection events, but all recovered after treatment. Other adverse effects were mild and acceptable. Microbiota diversity and composition, donor type, and other related issues were also analyzed. The data proves that FMT is a promising treatment modality of GVHD, but further validation of its safety and efficacy is still needed with prospective control studies.Clinical trial registration: Registered in https://www.crd.york.ac.uk/PROSPERO/ CRD42022296288.

摘要

本文通过系统的文献检索,对接受粪菌移植(FMT)治疗异基因造血干细胞移植(HSCT)后移植物抗宿主病(GVHD)的疗效和安全性进行评估,以开展一项纳入接受FMT治疗的GVHD患者研究的荟萃分析。纳入了23项研究,其中包括2项前瞻性队列研究、10项前瞻性单臂研究、2项回顾性单臂研究、2项病例系列研究和7项病例报告,共有242例继发于HSCT的激素抵抗或激素依赖型GVHD患者接受了FMT治疗。100例患者获得完全缓解,61例患者部分缓解,81例患者在FMT治疗后无效果。队列研究中临床缓解优势比估计值为5.51(95%置信区间1.49 - 20.35),前瞻性单臂研究中汇总临床缓解率为64%(51 - 77%),回顾性研究、病例系列研究和病例报告中为81%(62 - 95%)。5例(2.1%)患者发生了与FMT相关的感染事件,但均在治疗后康复。其他不良反应轻微且可接受。还分析了微生物群多样性和组成、供体类型及其他相关问题。数据证明FMT是一种有前景的GVHD治疗方式,但仍需要通过前瞻性对照研究进一步验证其安全性和疗效。临床试验注册:在https://www.crd.york.ac.uk/PROSPERO/CRD42022296288注册。

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