Human milk oligosaccharide (2'-FL) modifies the gut microbiome in children after bone marrow transplant.
Kristie N Ramos, Lucille Langenberg, Kelly E Lake et al.
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In 30 seconds
This prospective phase 1/2 clinical trial evaluated daily oral 2′-fucosyllactose (2′-FL), a human milk oligosaccharide, from conditioning through day +30 in children undergoing allogeneic hematopoietic stem cell transplantation. Seventy patients received 2′-FL; outcomes were compared with 29 age-matched contemporary controls from an institutional biorepository. 2′-FL was reported as safe and well tolerated, and microbiome diversity was preserved while it declined in controls. Grade II–IV acute gastrointestinal graft-versus-host disease occurred in 0% of recipients versus 17% of controls (P = .009).
Key findings
- Shannon diversity was preserved in 2′-FL recipients and declined from baseline to day +30 in controls (P = .04).
- Bifidobacteria and Blautia showed higher association with 2′-FL in adjusted analysis (adjusted P< .05).
- Grade II–IV acute GI GVHD incidence was 0% with 2′-FL versus 17% in controls (P = .009).
- Adenovirus reactivation was 0% in 2′-FL recipients versus 17% in controls (P = .009).
Why it matters
Microbiome disruption after allo-HSCT is linked to gastrointestinal GVHD. These findings suggest that a prebiotic intervention may preserve microbial diversity and coincide with differences in clinically relevant transplant outcomes. The study also reports changes in microbial taxa and metabolites associated with intestinal epithelial protection, supporting further evaluation of microbiome-directed approaches in this setting.
What to keep in mind
The comparison used contemporary biorepository controls rather than a randomised control group, so differences in GVHD and adenovirus reactivation cannot be attributed to 2′-FL with certainty. Correlative analyses included patients with at least 60% adherence.