High-risk LGI Acute GVHD treatment with third-party FMT
DeFilipp Z, Damania AV, Kim HT, et al. Third-Party Fecal Microbiota Transplantation for High-Risk Treatment-Naive Acute GVHD of the Lower GI Tract. Blood Advances. 2024; (doi: 10.1182/bloodadvances.2024012556).
Based on promising results with third-party fecal microbiota transplantation (FMT), scientists are urged to explore microbiome-targeted interventions as an early treatment for acute graft-versus-host disease (GVHD) of the lower gastrointestinal (LGI) tract. In a pilot study, nine participants with high-risk, treatment-naive acute LGI GVHD and one patient with steroid-refractory disease received third-party, single-donor FMT plus systemic corticosteroids. Treatment began with an induction dose consisting of 15 capsules per day for 2 consecutive days, followed by 3 weekly maintenance doses of 15 capsules each. All but one patient completed the full course of medication, satisfying the primary outcome of feasibility — defined as ≥80% of the study sample successfully swallowing ≥40 of the 75 capsules. Initial clinical response occurred within 1 week for all responders; and the responses were durable, with no recurrent LGI GVHD in complete responders. Through exploratory analyses, the investigators observed an increase in alpha diversity post-FMT and an expansion of donor-specific microbial species.