Ernst Holler, MD, University Hospital Regensburg, Regensburg, Germany, discusses whether gut decontamination should be performed pre-transplant for patients with hematological malignancies. Prof. Holler describes the rationale for gut decontamination, highlighting it’s potential protection against severe graft-versus-host disease (GvHD) and reduction of the risk of gram negative bacterial infections. Whilst 57% of practices perform gut decontamination in patients before transplant, Prof. Holler reports that true decontamination is rarely achieved and the resulting dysbiosis – a reduction in microbial diversity – is associated with increased gastrointestinal GvHD and poorer outcomes. Prof. Holler then goes on to discuss how modern advances in the ability to analyse gut microbiota have confirmed that complete gut decontamination confers a reduction in severe GvHD. Research has also indicated that reduction in translocation of bacteria from the stool and gut lumen to tissues could also contribute to a reduction in neutrophils, inflammation and GvHD-inducing cells. This interview took place at the 6th Congress on Controversies in Stem Cell Transplantation and Cellular Therapies (COSTEM), which took place virtually.
