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EBMT 2026 | The role of the microbiome in transplant & cellular therapy: exploring modulation with FMT
Hendrik Poeck, MD, University Hospital Regensburg, Regensburg, Germany, emphasizes the crucial role of the microbiome in modulating response rates and toxicities in allogeneic transplantation and cellular therapies, and discusses several strategies being explored to modulate the microbiome, including fecal microbiota therapy (FMT). Dr Poeck notes that while progress is being made, particularly in the setting of allogeneic transplant, further research is needed to characterize FMT products and the host to enable a precision-based approach. This interview took place at the 52nd Annual Meeting of the EBMT in Madrid, Spain.
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Transcript
So the microbiome is playing a crucial role in modulating response rates in allogeneic stem cell transplantation as well as toxicities like graft-versus-host disease. It’s also really important for modulating response rates in cellular therapies like CAR T-cell therapies and currently there are several strategies that are employed to use the microbiome for treatment or make cellular therapies and outcomes of allogeneic stem cell transplantation better...
So the microbiome is playing a crucial role in modulating response rates in allogeneic stem cell transplantation as well as toxicities like graft-versus-host disease. It’s also really important for modulating response rates in cellular therapies like CAR T-cell therapies and currently there are several strategies that are employed to use the microbiome for treatment or make cellular therapies and outcomes of allogeneic stem cell transplantation better. So the first one is called fecal microbiota transfer or microbial transfer and we’ve heard a little bit about that during the conference already in the ARES study that was presented by Florent Mallard. It’s actually a milestone where patients that are refractory to steroid and ruxolitinib treatment received an FMT and have really encouraging response rates. So maybe the first microbial therapy that could be used to treat GVHD that is refractory to standard treatment. And in the case of cellular therapies, we are still at the beginning. We are currently employing antibiotic stewardship strategies, but also the role of FMT will be explored in future clinical trials that are currently planned.
We are actually on the way of implementing microbiome-based strategies in transplant and also in cellular therapies. I think we are a little bit further ahead in allogeneic transplant and I just referred to the ARES trial that was presented by Florent Mallard at this conference. So there we already have a microbiome-based therapy, which is an enema, to improve GVHD outcomes. So, there we are already on the right track. In cellular therapy, we are still lacking behind. I mean, we still need to see the first results of FMT trials in patients with myeloma or NHL. Let’s see how that goes. And we will need to define what is a good FMT product. We still don’t know really what are the key mediators within the product. I think we need to characterize the product a little bit better. We need to characterize the host a lot better to understand which product fits the recipient like a precision FMT approach. So I think understanding more about what mediates the beneficial effects is important for the future to really open up a new field of therapies.
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