Fit for cure? Microbiota and GVHD

Abstract

In this issue of Blood, Kakihana et al report for the first time successful and safe application of related fecal microbiota transplants (FMTs) via nasoduodenal tubes in a small series of patients suffering from steroid-resistant acute intestinal graft-versus-host disease (GVHD). In spite of concomitant cytomegalovirus and Aspergillus infections at the start of treatment, adverse effects were limited and mainly related to the mode of application. Three of 4 patients responded at the end of the observational period of 28 days after first FMT, allowing reduction of concomitant steroid dose by 69%. Four-week response was associated with restoration of commensal microbiota and accompanied by an increase of the effector regulatory T-cell/CD8 T-cell ratio in 3 of 4 patients. In the 3 responding patients, improvement of gut symptoms persisted after the last FMT, with 1 patient being alive 2 years after FMT and 2 patients finally relapsing from underlying disease 106 days and 1 year, respectively, after FMT without recurrence of GVHD.1