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ISAL 2025 | The potential of manipulating the gut microbiome to improve responses to immunotherapy in AML
Hendrik Poeck, MD, University Hospital Regensburg, Regensburg, Germany, discusses the critical role of the microbiome in immunotherapy for acute myeloid leukemia (AML). He highlights how broad-spectrum antibiotics can negatively impact treatment efficacy and contribute to immune-mediated side effects such as graft-versus-host disease, cytokine release syndrome, and neurotoxicity. Future research may enable microbiome-based interventions to enhance graft-versus-leukemia effects, minimize immune-related toxicities, and improve CAR T-cell responses. This interview took place at the 19th International Symposium on Acute Leukemias (ISAL XIX) in Munich, Germany.
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Transcript
The role of the microbiome is emerging over the past years, in particular in immunotherapy. It has a tremendous role, it’s especially evident if you look at the data in patients receiving immune checkpoint block but also in patients that received an allogeneic stem cell transplantation as well as receiving CAR T-cells We know that the application of broad-spectrum antibiotics is detrimental for the efficacy of these cancer immunotherapies and also drives the emergence of immune mediated side effects, for example the emergence of graft-versus-host disease but also for example CRS or ICANS following CAR T-cell therapies...
The role of the microbiome is emerging over the past years, in particular in immunotherapy. It has a tremendous role, it’s especially evident if you look at the data in patients receiving immune checkpoint block but also in patients that received an allogeneic stem cell transplantation as well as receiving CAR T-cells We know that the application of broad-spectrum antibiotics is detrimental for the efficacy of these cancer immunotherapies and also drives the emergence of immune mediated side effects, for example the emergence of graft-versus-host disease but also for example CRS or ICANS following CAR T-cell therapies. We can probably use the microbiome in the future in a way to modulate these responses but for that we still need a better understanding how the microbiome mediates all these responses and they’re pretty good candidates first of all I would say that certain bacteria species that produce certain messengers such as metabolites could be used for example to enhance graft-versus-leukemia effects but also maybe to minimize immune mediated side effects and also drive CAR T-cell responses.
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