Fecal microbiota transplantation for patients with steroid-resistant acute graft-versus-host disease of the gut

Kazuhiko Kakihana, Yuki Fujioka, Wataru Suda, Yuho Najima, Go Kuwata, Satoshi Sasajima, Iyo Mimura, Hidetoshi Morita, Daisuke Sugiyama, Hiroyoshi Nishikawa, Masahira Hattori, Yutaro Hino, Shuntaro Ikegawa, Keita Yamamoto, Takashi Toya, Noriko Doki, Koichi Koizumi, Kenya Honda and Kazuteru Ohashi

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  • RE: Fecal microbiota transplantation after allogeneic stem cell transplantation: Does the feces donor matter?
    • Christine Robin, Hematologist Henri Mondor University Hospital Créteil France
    • Other Contributors:
      • Muriel Paul, Pharmacist
      • Biba Nebbad, Microbiologist
      • Florence Beckerich, Hematologist
      • Raphael Lepeule, Infectious Diseases Specialist
      • Nawel Ait Ammar, Mycologist
      • Christophe Rodriguez, Virologist
      • Andréa Toma, Hematologist
      • Catherine Cordonnier, Hematologist

    To the Editor

    We read with interest the article by Kakihana K. et al [1] on fecal microbiota transplantation (FMT) in four patients with graft-versus-host disease (GVHD). As the loss of gut microbial diversity after allogeneic HSCT is associated with GVHD and mortality [2], and restoring microbiota diversity could control GVHD in animals, investigating FMT in GVHD is logical. The previous experience of FMT after allogeneic HSCT was limited to the treatment of recurrent C.difficile infection (CDI), another condition of loss of gut microbial diversity [3-5]. Kakihana et al. interestingly add to the safety experience of FMT, and open new insights in GVHD treatment. However, they do not discuss the choice of the feces donor which, in our opinion, may be important.
    We performed a FMT in a 51-year-old patient transplanted from his HLA-identical sister for chronic lymphocytic leukemia. After 3 recurrent CDI episodes, we considered a FMT while he was receiving cyclosporine and steroids for grade II cutaneous and liver GVHD and an uncontrolled obstructive pulmonary syndrome. In the lack of consensus criteria to choose the feces donor, we decided to solicit his sister - the HSCT donor - for feces donation and proceeded to FMT on day 358. FMT was safe, CDI definitely cured, GVHD and pulmonary tests improved.
    Among the 13 published cases of FMT after allogeneic HSCT (table 1), the feces donor was a patient’s relative or a volunteer, never the HSCT donor. There is no...

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    Conflict of Interest:
    None declared.