Gut microbiota diversity after autologous fecal microbiota transfer in acute myeloid leukemia patients (Équipe Mohty)

Florent Malard, Anne Vekhoff, Simona Lapusan, Françoise Isnard, Évelyne D'incan-Corda, Jérôme Rey, Colombe Saillard, Xavier Thomas, Sophie Ducastelle-Lepretre, Étienne Paubelle, Marie-Virginie Larcher, Clément Rocher, Christian Recher, Suzanne Tavitian, Sarah Bertoli, Anne-SophieMichallet, Lila Gilis, Pierre Peterlin, Patrice Chevallier, Stéphanie Nguyen, Émilie Plantamura, Lilia Boucinha, Cyrielle Gasc, Mauricette Michallet, Joël Dore, Ollivier Legrand, Mohamad Mohty

Nat Commun 12 (2021): 3084

Acute myeloid leukemia (AML) intensive chemotherapy combined with broad-spectrum antibiotics, leads to gut microbiota dysbiosis promoting pathological conditions and an increased incidence of complications. Here we report findings from a phase II single-arm, multicenter study evaluating autologous fecal microbiota transfer (AFMT) in 25 AML patients treated with intensive chemotherapy and antibiotics ( number: NCT02928523). The co-primary outcomes of the study are to evaluate the efficacy of AFMT in dysbiosis correction and multidrug-resistant bacteria eradication. The main secondary outcomes are to define a dysbiosis biosignature, to evaluate the effect of dysbiosis correction on patient clinical status, to assess the short and mid-term safety of AFMT in this immunocompromised population, and to evaluate the feasibility of the AFMT procedure and acceptability by the patient. Intensive induction chemotherapy induces a dramatic decrease of alpha-diversity indices, and a microbial dysbiosis with a significant shift of the microbial communities and domination of pro-inflammatory families. After AFMT treatment, alpha-diversity indices return to their initial mean levels and the similarity index shows the restoration of microbial communities. The trial meets pre-specified endpoints. AFMT appears to be safe and may be effective for gut microbiota restoration in AML patients receiving intensive chemotherapy and antibiotics, with an excellent gut microbiota reconstruction based on both richness and diversity indices at the species level.

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