Treating Steroid Refractory Intestinal Acute Graft-vs.-Host Disease With Fecal Microbiota Transplantation: A Pilot Study

Xiaofei Qi, Xuewei Li, Ye Zhao, Xiaojin Wu, Feng Chen, Xiao Ma, Faming Zhang, Depei Wu, Xiaofei Qi, Xuewei Li, Ye Zhao, Xiaojin Wu, Feng Chen, Xiao Ma, Faming Zhang, Depei Wu

Abstract

Patients with steroid refractory gastrointestinal (GI) tract graft- vs.-host disease (GvHD) face a poor prognosis and limited therapeutic options. To accurately assess the efficacy and safety of fecal microbiota transplantation (FMT) in treating steroid refractory GI tract GvHD, we conducted a pilot study involving eight patients. Having received FMTs, all patients' clinical symptoms relieved, bacteria enriched, and microbiota composition reconstructed. Compared to those who did not receive FMT, these eight patients achieved a higher progression-free survival. FMT can serve as a therapeutic option for GI tract aGVHD, but its effectiveness and safety need further evaluations. Clinical Trial Registration: NCT03148743.

Keywords: a pilot study; diarrhea; fecal microbiota transplantations; graft-vs.-host disease; refractory gastrointestinal.

Figures

Figure 1
Figure 1
Clinical response to FMT. (A) Stool volumes of all 8 patients pre FMT and 13 days post FMT. (B) Stool frequency of all 8 patients pre FMT and 13 days post FMT. (C) Abdominal pain score at baseline and 13 days follow-up after FMT (n = 4).
Figure 2
Figure 2
Analysis of fecal microbiota in donor and 6 patients. (A) The diversity of fecal microbiota in all sample (Shannon's diversity index). Px means patient number, Dx means donor number, xD means day after FMT. (B) Shannon's diversity index change in donor group, pre-FMT and post-FMT samples. **p < 0.01.
Figure 3
Figure 3
Change of fecal microbiota before and after FMT. (A) Analysis of fecal microbiota composition in all samples at the phylum level. (B) Analysis of fecal microbiota composition in all samples at the genus level. Difference of fecal microbiota composition between pre-FMT and post-FMT at the phylum level (C). (D) Genus level.
Figure 4
Figure 4
Efficacy and safety of FMT. (A) Progression free survival (PFS) between patients treated with FMT and without FMT in 90 days after the steroid refractory GI-GvHD being diagnosed. (B) Overall survival (OS) in the refractory and steroid- insensitive GI-GvHD patients who treated with FMT/without FMT were shown. Days means day after the steroid refractory GI-GvHD being diagnosed.

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