TY - JOUR
T1 - Safety of Probiotics Among High-Risk Pediatric Hematopoietic Stem Cell Transplant Recipients
AU - Sadanand, Arhanti
AU - Newland, Jason G.
AU - Bednarski, Jeffrey J.
N1 - Funding Information:
The authors acknowledge the clinical staff, patients, and families at St. Louis Children’s Hospital. No funding or sponsorship was received for this study or publication of this article. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published. Arhanti Sadanand, Jason Newland, and Jeffrey Bednarski have nothing to disclose. Jason Newland is a member of the journal’s Editorial Board. All procedures performed in studies involving human participants were in accordance with the ethical standards of the Washington University in St. Louis Institutional Review Board (IRB# 201705120) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The need for informed consent was waived due to the retrospective nature and the minimal risk of the study. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/), which permits any noncommercial use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
Publisher Copyright:
© 2019, The Author(s).
PY - 2019/6/1
Y1 - 2019/6/1
N2 - Introduction: Increased diversity of the intestinal microbiome has been significantly associated with lower mortality after hematopoietic stem cell transplant (HSCT). Probiotics, such as Lactobacillus species with defined probiotic potential, may have beneficial properties including restoration of commensal species to the intestinal tract, anti-microbial effects, and healing of the intestinal mucosa. However, the use of probiotics in immune-compromised patients raises concerns, specifically regarding the risk for possible Lactobacillus bacteremia. Risk of bacteremia is an even greater concern in HSCT patients with breakdown of mucosal barriers, specifically patients with Clostridium difficile infection (CDI) or gastrointestinal graft-versus-host disease (GVHD). Minimal data have been reported on the safety of probiotics in these high-risk HSCT populations. Methods: We performed a retrospective study of allogeneic HSCT recipients at our institution between 2011 and 2016, and identified 14 patients (median age 7 years) prescribed probiotics, 10 of whom received probiotics prior to day 100 after HSCT. Results: Eight of ten patients were diagnosed with acute GVHD, four of whom (40%) specifically had acute GVHD involving the gastrointestinal tract. Five patients (50%) on probiotics prior to day 100 were diagnosed with CDI (median onset at day 13 post-transplant). There were no cases of Lactobacillus bacteremia, including in patients with GVHD or CDI. Conclusion: This small case series supports the safe use of probiotics in a high-risk population of pediatric HSCT patients with compromised intestinal mucosal integrity. Further studies are needed to determine if probiotics have benefit in preventing and treating gastrointestinal GVHD or CDI.
AB - Introduction: Increased diversity of the intestinal microbiome has been significantly associated with lower mortality after hematopoietic stem cell transplant (HSCT). Probiotics, such as Lactobacillus species with defined probiotic potential, may have beneficial properties including restoration of commensal species to the intestinal tract, anti-microbial effects, and healing of the intestinal mucosa. However, the use of probiotics in immune-compromised patients raises concerns, specifically regarding the risk for possible Lactobacillus bacteremia. Risk of bacteremia is an even greater concern in HSCT patients with breakdown of mucosal barriers, specifically patients with Clostridium difficile infection (CDI) or gastrointestinal graft-versus-host disease (GVHD). Minimal data have been reported on the safety of probiotics in these high-risk HSCT populations. Methods: We performed a retrospective study of allogeneic HSCT recipients at our institution between 2011 and 2016, and identified 14 patients (median age 7 years) prescribed probiotics, 10 of whom received probiotics prior to day 100 after HSCT. Results: Eight of ten patients were diagnosed with acute GVHD, four of whom (40%) specifically had acute GVHD involving the gastrointestinal tract. Five patients (50%) on probiotics prior to day 100 were diagnosed with CDI (median onset at day 13 post-transplant). There were no cases of Lactobacillus bacteremia, including in patients with GVHD or CDI. Conclusion: This small case series supports the safe use of probiotics in a high-risk population of pediatric HSCT patients with compromised intestinal mucosal integrity. Further studies are needed to determine if probiotics have benefit in preventing and treating gastrointestinal GVHD or CDI.
KW - Clostridium difficile infection
KW - Graft-versus-host disease
KW - Lactobacillus rhamnosus (Culturelle)
KW - Pediatrics
KW - Probiotics
KW - Stem cell transplant
UR - http://www.scopus.com/inward/record.url?scp=85064681158&partnerID=8YFLogxK
U2 - 10.1007/s40121-019-0244-3
DO - 10.1007/s40121-019-0244-3
M3 - Article
C2 - 30989592
AN - SCOPUS:85064681158
SN - 2193-8229
VL - 8
SP - 301
EP - 306
JO - Infectious Diseases and Therapy
JF - Infectious Diseases and Therapy
IS - 2
ER -