Overall, the researchers established that these results may help elucidate the essential mechanisms influencing clinical outcomes and complications following allogeneic HSCT. Furthermore, they suggested that these findings could form the basis to investigate or modify other possible molecular targets.

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Use of Probiotics to Alter Microbiota

Current literature has suggested that modifying the composition of gut microbiota may ameliorate some of the negative effects often experienced with acute GVHD.

“Use of probiotics, which utilize the administration of live microorganisms, is one approach that can alter the microbial architecture,” Dr Riwes said. “Experimental studies have shown that [the] use of probiotics in mice reduced acute GVHD following allogeneic HSCT.”

While this approach has demonstrated efficacy in animal studies, the technique has also been associated with certain safety concerns.3 “There are major safety concerns in administering probiotics to immunocompromised allogeneic HSCT patients, namely the risk of bacterial translocation and sepsis,” Dr Riwes added.

Joseph H Antin, MD, of the department of medical oncology at the Dana-Farber Cancer Institute in Boston, Massachusetts, told Hematology Advisor, “[Currently], there are no data indicating that probiotics are helpful in treating or preventing GVHD.”

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Other Approaches and Moving Forward

Alternatively, Dr Riwes recommended the use of a different strategy: fecal microbiota transplantation, which she says, “has been shown to be safe and potentially efficacious in the treatment of acute GVHD in allogeneic HSCT patients.”

The clinical significance of modifying metabolite levels, such as fecal propionate and butyrate, to change microbial composition remains unknown.

“The use of these approaches to alter the microbiota seems promising. However, larger studies are needed to further investigate their efficacy and safety in allogeneic HSCT patients,” Dr Riwes concluded.


1. Riwes M, Reddy P. Microbes and Their Metabolites Correlate with Hematopoietic Stem Cell Transplantation Outcomes? [published online November 12, 2018]. Biol Blood Marrow Transplant. doi: 10.1016/j.bbmt.2018.11.006

2. Jacobsohn DA, Vogelsang GB. Acute graft versus host disease. Orphanet J Rare Dis. 2007;2:35. doi: 10.1186/1750-1172-2-35

3. Ladas EJ, Bhatia M, Chen L, et al. The safety and feasibility of probiotics in children and adolescents undergoing hematopoietic cell transplantation. Bone Marrow Transplant. 2016;51(2):262-266. doi: 10.1038/bmt.2015.275