Li Anna, Bowen Joanne M, Ball Imogen A, Wilson Sophie, Yong Angelina, Yeung David T, Lee Cindy H, Bryant Robert V, Costello Samuel P, Ryan Feargal J, Wardill Hannah R
School of Biomedicine, The University of Adelaide, Adelaide, SA 5000, Australia.
Supportive Oncology Research Group, Precision Cancer Medicine, The South Australian Health and Medical Research Institute, Adelaide, SA 5001, Australia.
Biomedicines. 2023 Dec 11;11(12):3274. doi: 10.3390/biomedicines11123274.
Haematopoietic stem cell transplantation (HSCT) is a curative approach for blood cancers, yet its efficacy is undermined by a range of acute and chronic complications. In light of mounting evidence to suggest that these complications are linked to a dysbiotic gut microbiome, we aimed to evaluate the feasibility of faecal microbiota transplantation (FMT) delivered during the acute phase after HSCT. Of note, this trial opted for FMT prepared using the individual's own stool (autologous FMT) to mitigate the risks of disease transmission from a donor stool. Adults (>18 years) with multiple myeloma were recruited from a single centre. The stool was collected prior to starting first line therapy. Patients who progressed to HSCT were offered FMT via 3 × retention enemas before day +5 (HSCT = day 0). The feasibility was determined by the recruitment rate, number and volume of enemas administered, and the retention time. Longitudinally collected stool samples were also collected to explore the influence of auto-FMT using 16S rRNA gene sequencing. = 4 (2F:2M) participants received auto-FMT in 12 months. Participants received an average of 2.25 (1-3) enemas 43.67 (25-50) mL total, retained for an average of 60.78 (10-145) min. No adverse events (AEs) attributed to the FMT were identified. Although the minimum requirements were met for the volume and retention of auto-FMT, the recruitment was significantly impacted by the logistical challenges of the pretherapy stool collection. This ultimately undermined the feasibility of this trial and suggests that third party (donor) FMT should be prioritised.
造血干细胞移植（HSCT）是治疗血癌的一种有效方法，但其疗效会受到一系列急慢性并发症的影响。鉴于越来越多的证据表明这些并发症与肠道微生物群失调有关，我们旨在评估HSCT急性期进行粪便微生物群移植（FMT）的可行性。值得注意的是，该试验选择使用个体自身粪便制备的FMT（自体FMT），以降低供体粪便传播疾病的风险。从单一中心招募了年龄大于18岁的多发性骨髓瘤成年患者。在开始一线治疗前收集粪便。进展到HSCT的患者在+5天前通过3次保留灌肠接受FMT（HSCT = 0天）。通过招募率（招募率）、灌肠给药的次数和体积以及保留时间来确定可行性。还纵向收集粪便样本，以使用16S rRNA基因测序探索自体FMT的影响。12个月内有4名（2名女性：2名男性）参与者接受了自体FMT。参与者平均接受2.25次（1 - 3次）灌肠，总量为43.67 mL（25 - 50 mL），平均保留60.78分钟（10 - 145分钟）。未发现归因于FMT的不良事件（AE）。虽然自体FMT的体积和保留时间达到了最低要求，但治疗前粪便收集的后勤挑战对招募产生了显著影响。这最终削弱了该试验的可行性，并表明应优先考虑第三方（供体）FMT。
