NEJM:肠道菌群多样性可预测骨髓移植后的死亡风险
创作:mildbreeze 审核:mildbreeze 03月01日
  • 纳入4个医疗中心(2个队列)1362例接受异体造血细胞移植的患者,分析粪便菌群及与随访期间死亡风险的关联;
  • 治疗过程中患者菌群多样性降低,并出现单菌优势(肠球菌和链球菌最常见);
  • 移植后7-21天期间的菌群多样性与死亡风险相关,2个队列中高菌群多样性患者的死亡风险分别降低29%和51%,但在接受去除T细胞的移植物的患者中未见这种关联;
  • 患者移植前的菌群多样性已低于健康人,基线菌群多样性低也与死亡率升高相关。
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mildbreeze
NEJM最新发表的一项多国家多中心临床研究,分析了1362例接受异体造血细胞移植的患者的肠道菌群特征和多样性与临床结局的关系,表明在中性粒细胞植入时,较低的菌群多样性与之后患者死亡风险升高存在显著关联,提示恢复菌群多样性的干预方法或能作为辅助治疗手段,以改善患者预后。
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Microbiota as Predictor of Mortality in Allogeneic Hematopoietic-Cell Transplantation

菌群作为同种异体造血细胞移植死亡率的预测因子

10.1056/NEJMoa1900623

02-27, Article

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BACKGROUND: Relationships between microbiota composition and clinical outcomes after allogeneic hematopoietic-cell transplantation have been described in single-center studies. Geographic variations in the composition of human microbial communities and differences in clinical practices across institutions raise the question of whether these associations are generalizable.
METHODS: The microbiota composition of fecal samples obtained from patients who were undergoing allogeneic hematopoietic-cell transplantation at four centers was profiled by means of 16S ribosomal RNA gene sequencing. In an observational study, we examined associations between microbiota diversity and mortality using Cox proportional-hazards analysis. For stratification of the cohorts into higher- and lower-diversity groups, the median diversity value that was observed at the study center in New York was used. In the analysis of independent cohorts, the New York center was cohort 1, and three centers in Germany, Japan, and North Carolina composed cohort 2. Cohort 1 and subgroups within it were analyzed for additional outcomes, including transplantation-related death.
RESULTS: We profiled 8767 fecal samples obtained from 1362 patients undergoing allogeneic hematopoietic-cell transplantation at the four centers. We observed patterns of microbiota disruption characterized by loss of diversity and domination by single taxa. Higher diversity of intestinal microbiota was associated with a lower risk of death in independent cohorts (cohort 1: 104 deaths among 354 patients in the higher-diversity group vs. 136 deaths among 350 patients in the lower-diversity group; adjusted hazard ratio, 0.71; 95% confidence interval [CI], 0.55 to 0.92; cohort 2: 18 deaths among 87 patients in the higher-diversity group vs. 35 deaths among 92 patients in the lower-diversity group; adjusted hazard ratio, 0.49; 95% CI, 0.27 to 0.90). Subgroup analyses identified an association between lower intestinal diversity and higher risks of transplantation-related death and death attributable to graft-versus-host disease. Baseline samples obtained before transplantation already showed evidence of microbiome disruption, and lower diversity before transplantation was associated with poor survival.
CONCLUSIONS: Patterns of microbiota disruption during allogeneic hematopoietic-cell transplantation were similar across transplantation centers and geographic locations; patterns were characterized by loss of diversity and domination by single taxa. Higher diversity of intestinal microbiota at the time of neutrophil engraftment was associated with lower mortality. (Funded by the National Cancer Institute and others.)

First Authors:
JU Peled,ALC Gomes

Correspondence Authors:
EG Pamer,MRM van den Brink

All Authors:
JU Peled,ALC Gomes,SM Devlin,ER Littmann,Y Taur,AD Sung,D Weber,D Hashimoto,AE Slingerland,JB Slingerland,M Maloy,AG Clurman,CK Stein‑Thoeringer,KA Markey,MD Docampo,M Burgos da Silva,N Khan,A Gessner,JA Messina,K Romero,MV Lew,A Bush,L Bohannon,DG Brereton,E Fontana,LA Amoretti,RJ Wright,GK Armijo,Y Shono,M Sanchez‑Escamilla,N Castillo Flores,A Alarcon Tomas,RJ Lin,L Yáñez San Segundo,GL Shah,C Cho,M Scordo,I Politikos,K Hayasaka,Y Hasegawa,B Gyurkocza,DM Ponce,JN Barker,M-A Perales,SA Giralt,RR Jenq,T Teshima,NJ Chao,E Holler,JB Xavier,EG Pamer,MRM van den Brink

图片
Nature Reviews Clinical Oncology期刊

Intestinal microbiota predict HSCT outcome

2020-03-16

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