Treatment of intestinal graft-versus-host disease with unrelated donor fecal microbiota transplantation capsules: A case report.

Abstract

INTRODUCTION:

Fecal microbiota transplantation (FMT), administering fecal suspensions via a nasoduodenal tube, has achieved a promising effect in the treatment of intestinal graft-versus-host disease (GvHD) in some pilot studies. In this study, oral FMT capsules from unrelated donor were used for the first time in the treatment of intestinal GvHD. Patient concerns: A 31-year-old male who was diagnosed as "myelodysplastic syndromes with excess blasts II" (intermediate risk 2 of international prognostic scoring system) received human leukocyte antigen -matched sibling donor allogeneic hematopoietic stem cell transplantation. The patient developed diarrhea, vomiting, and bloody stool on 28 days after transplantation.

DIAGNOSIS:

Intestinal acute GvHD was diagnosed clinically with histological confirmation by colonoscopy and pathological biopsy.

INTERVENTIONS:

This patient was treated with first cycle of oral FMT capsules after failure to initial treatment of methylprednisolone (2 mg/kg/d) combined with recombinant human tumor necrosis factor-α receptorII: IgG Fc fusion protein (25 mg, biw). The symptoms of intestinal GvHD were relieved but recurred 11 days later. Second cycle of oral FMT capsules was carried out.

OUTCOMES:

After 2 cycles of fecal bacteria transplantation, intestinal GvHD was gradually controlled and did not recur again during the 2-month follow-up. The diversity and structure of the intestinal flora after FMT was closer to that of healthy donors than that before.

CONCLUSION:

Our case showed oral FMT capsules could be used as a treatment option for corticosteroid refractory intestinal GvHD. Further studies are warranted to assess the clinical efficacy and safety of oral FMT capsules in the treatment of intestinal GvHD.

RATIONALE:

Fecal microbiota transplantation (FMT), administering fecal suspensions via a nasoduodenal tube, has achieved a promising effect in the treatment of intestinal graft-versus-host disease (GvHD) in some pilot studies. In this study, oral FMT capsules from unrelated donor were used for the first time in the treatment of intestinal GvHD.

PATIENT CONCERNS:

A 31-year-old male who was diagnosed as "myelodysplastic syndromes with excess blasts II" (intermediate risk 2 of international prognostic scoring system) received human leukocyte antigen -matched sibling donor allogeneic hematopoietic stem cell transplantation. The patient developed diarrhea, vomiting, and bloody stool on 28 days after transplantation.

DIAGNOSES:

Intestinal acute GvHD was diagnosed clinically with histological confirmation by colonoscopy and pathological biopsy.

INTERVENTIONS:

This patient was treated with first cycle of oral FMT capsules after failure to initial treatment of methylprednisolone (2 mg/kg/d) combined with recombinant human tumor necrosis factor-a receptorII: IgG Fc fusion protein (25 mg, biw). The symptoms of intestinal GvHD were relieved but recurred 11 days later. Second cycle of oral FMT capsules was carried out.

OUTCOMES:

After 2 cycles of fecal bacteria transplantation, intestinal GvHD was gradually controlled and did not recur again during the 2-month follow-up. The diversity and structure of the intestinal flora after FMT was closer to that of healthy donors than that before.

CONCLUSION:

Our case showed oral FMT capsules could be used as a treatment option for corticosteroid refractory intestinal GvHD. Further studies are warranted to assess the clinical efficacy and safety of oral FMT capsules in the treatment of intestinal GvHD.

LESSONS:

There is still a possibility of recurrence after the treatment of GvHD with capsule fecal microbiota transplantation. How to optimize the dosage and treatment course of fecal microbiota capsule administration needs further exploration.

• Authors: Dan Mao, Qi Jiang, Ye Sun, Yubo Mao, Lili Guo, Yanqing Zhang, Muran Man, Guifang Ouyang, Lixia Sheng
• Journal: Medicine (Medicine (Baltimore)) Vol. 99 Issue 38 Pg. e22129 (Sep 18 2020) ISSN: 1536-5964 [Electronic] United States
• PMID: 32957333 (Publication Type: Case Reports, Journal Article)

Chemical References

• Capsules

Topics

• Adult
• Capsules
• Fecal Microbiota Transplantation
• Graft vs Host Disease (therapy)
• Hematopoietic Stem Cell Transplantation
• Humans
• Intestinal Diseases (therapy)
• Male
• Myelodysplastic Syndromes (therapy)
• Unrelated Donors