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The gut microbiome in pediatric patients undergoing allogeneic hematopoietic stem cell transplantation
Riccardo Masetti1, Daniele Zama1, Davide Leardini1
1Pediatric Oncology and Hematology Unit "Lalla Seràgnoli," Department of Pediatrics, University of Bologna, Sant'Orsola Malpighi Hospital, Bologna, Italy.
Insights
The gut microbiome (GM) impacts outcomes in pediatric allogeneic hematopoietic stem cell transplantation (HSCT). This review highlights age-specific GM factors influencing immune reconstitution and clinical results in children undergoing HSCT.
Area of Science:
- Pediatric Hematology
- Microbiology
- Immunology
Background:
- The gut microbiome (GM) influences outcomes in adult allogeneic hematopoietic stem cell transplantation (HSCT).
- Limited data exist on GM's role in pediatric HSCT, despite unique developmental and procedural differences.
- GM is a potential therapeutic target for improving HSCT outcomes.
Purpose of the Study:
- To review the current evidence on the gut microbiome in pediatric HSCT.
- To highlight age-specific considerations regarding GM in children.
- To discuss GM-based therapeutic strategies for pediatric HSCT.
Main Methods:
- Comprehensive literature review of studies on GM and pediatric HSCT.
- Analysis of age-dependent GM evolution and immune system maturation.
- Evaluation of GM's impact on immune reconstitution and clinical outcomes.
Main Results:
- Childhood GM undergoes rapid, fluctuating changes concurrent with immune system development.
- Pediatric HSCT procedures differ significantly from adult protocols.
- GM's age-dependent trajectory is crucial for immune recovery and HSCT success in children.
Conclusions:
- Understanding the pediatric gut microbiome is essential for optimizing HSCT outcomes.
- Age-specific GM trajectories significantly influence immune reconstitution post-HSCT in children.
- GM-targeted therapies hold promise for improving pediatric HSCT care.
Abstract:
The gut microbiome (GM) has been associated with different clinical outcomes in the context of allogeneic hematopoietic stem cell transplantation (HSCT). Large multicenter cohort studies in adults have found significant correlations with overall survival, relapse, and incidence of complications. Moreover, GM is already a promising target for therapeutic interventions. However, few data are available in children, a population presenting unique features and challenges. During childhood, the GM evolves rapidly with large structural fluctuations, alongside with the maturation of the immune system. Furthermore, the HSCT procedure presents significant differences in children. These considerations underline the importance of a specific focus on the pediatric setting, and the role of GM and its age-dependent trajectory in influencing the immunity reconstitution and clinical outcomes. This review provides a comprehensive overview of the available evidence in the field of GM and pediatric HSCT, highlighting age-specific issues and discussing GM-based therapeutic approaches.
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