Gastrointestinal Microbiome and Mycobiome Changes during Autologous Transplantation for Multiple Myeloma: Results of a Prospective Pilot Study

https://doi.org/10.1016/j.bbmt.2019.04.007Get rights and content
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Highlights

  • Microbiome composition present at pretransplantation baseline is associated with the incidence and severity of post-transplantation nausea, vomiting, and neutropenic fever, and with the rate of neutrophil engraftment.

  • The microbial communities present at count nadir are associated with regimen-related gastrointestinal toxicities observed with high-dose melphalan.

  • Although bacteriome diversity largely recovers within 1 month after transplantation, recovery of oral and gastrointestinal mycobiome diversity takes longer to recover.

ABSTRACT

Microbiome dysbiosis has been associated with adverse outcomes of hematopoietic cell transplantation (HCT). We hypothesized that exposure to high-dose melphalan and antimicrobials in patients undergoing autologous HCT for plasma cell disorders results in oral and gastrointestinal microbial dysbiosis, which in turn is associated with regimen-related toxicities. We conducted a prospective study describing the longitudinal changes in oral and gastrointestinal bacteriome and mycobiome in this patient population. Our findings show that microbiome composition present at baseline is associated with the incidence and severity of post-transplantation nausea, vomiting, and culture-negative neutropenic fever, as well as with the rate of neutrophil engraftment. We also have evidence of an association between the microbial communities at count nadir and the development of regimen-related gastrointestinal toxicities commonly observed after exposure to high-dose melphalan. Although bacteriome diversity largely recovers within 1 month after transplantation, we observed a continuous decrease in oral and gastrointestinal mycobiome diversity, suggesting that the mycobiome requires a longer time to recover compared with the bacteriome.

Key Words

Microbiome
Bacteriome
Mycobiome
Transplantation
Toxicity

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Financial disclosure: See Acknowledgments on page 1518.