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Faecal microbiota transplant: a novel biological approach to extensively drug-resistant organism-related non-relapse mortality

Bone Marrow Transplantation volume 52, pages 1452–1454 (2017)Cite this article

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Extensively drug-resistant organisms (XDRO) are a global threat to health. Colonization with XDRO before hematopoietic cell transplantation (HCT) frequently results in delayed delivery of antimicrobials to which the organisms are susceptible and significantly increases non-relapse mortality. Their inherent resistance to available antimicrobial agents coupled with a preponderance to evolve further resistance makes biological approaches attractive. Suppression of pathogenic organisms by fecal microbiome transplantation has previously been demonstrated, and here we explain in detail the use of this approach to successfully suppress XDRO before HCT that permitted an uneventful transplant course in an otherwise high-risk situation.

Non-relapse mortality (NRM) of allogeneic haematopoietic cell transplantation (HCT) has progressively fallen over the last four decades. Better supportive care, particularly in managing infection, has significantly contributed to the improved safety over this period. However, antimicrobial resistance poses a significant global threat to health,1 and the emergence of extensively drug-resistant organisms (XDRO) within HCT units now poses a direct threat to transplant recipients.2 Gut colonisation with XDRO has been associated with increased NRM,3 and the management of XDRO infections during neutropenic periods is complex and associated with high mortality.2 Innovative approaches in preventing and managing them are therefore necessary to avoid reversing much of the progress made in limiting NRM over the last four decades.

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Acknowledgements

AJI and JFA are supported by the National Institute for Health Research Imperial Biomedical Research Centre. BHM is supported by Imperial College Healthcare Charity (grant number 161722).

Author contributions

AJI, BHM, FD, JRM, EB, JFA and JP conceived and implemented the treatment strategy and prepared the manuscript. BHM performed the procedure with the assistance of FF and GA, and the advice of JRM. All authors reviewed and revised the manuscript before approving the final draft.

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Authors and Affiliations

  1. Centre for Hematology, Faculty of Medicine, Imperial College London, London, UK

    A J Innes, J F Apperley & J Pavlů

  2. Department of Hematology, Imperial College Healthcare NHS Trust, London, UK

    A J Innes, F Fernando, G Adams, J F Apperley & J Pavlů

  3. Division of Digestive Diseases, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK

    B H Mullish & J R Marchesi

  4. Division of Organisms and Environment, School of Biosciences, Cardiff University, Cardiff, UK

    J R Marchesi

  5. Department of Infectious diseases and Immunity, Imperial College Healthcare NHS Trust, London, UK

    E Brannigan & F Davies

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  1. A J Innes
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  4. G Adams
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Correspondence to J Pavlů.

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Innes, A., Mullish, B., Fernando, F. et al. Faecal microbiota transplant: a novel biological approach to extensively drug-resistant organism-related non-relapse mortality. Bone Marrow Transplant 52, 1452–1454 (2017). https://doi.org/10.1038/bmt.2017.151

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