Table 1.
Summary of gut decontamination trials in alloHSCT patients
| Year (ref.) | Type of study | Patient population (n) | Comparison groups | GD regimen (all oral antibiotics) | Impact on acute GvHD incidence |
|---|---|---|---|---|---|
| 19789 | Prospective, randomized; single-center |
Adults undergoing alloHSCT with HLA-identical sibling donors for aplastic anemia or acute leukemia (90) |
LAF isolation with decontamination vs control (single room, minimal precautions, no decontamination) |
Variable, but included: gentamicin, mycostatin, vancomycin, paromomycin, polymyxin |
No difference in incidence, but significant difference in median time to onset of GvHD (48 days in LAF vs 24 days in control, P = 0.03) in aplastic anemia patients. No difference in incidence or time to onset of GvHD in acute leukemia patients. |
| 198310 | Retrospective analysis |
Adults undergoing alloHSCT with HLA-identical sibling donors for aplastic anemia (130) |
LAF isolation with decontamination vs control (single room, minimal precautions, no decontamination) |
Not described | Significantly lower cumulative grade II–IV GvHD incidence (P = 0.05) and significantly higher probability of survival (P = 0.03) in LAF with decontamination group. |
| 199011 | Retrospective analysis |
Pediatric patients undergoing alloHSCT with HLA-identical sibling donors for bone marrow failure or leukemia (65) |
Two different GD strategies (‘complete’ vs ‘selective’) |
‘Complete’ GD: neomycin, polymyxin B, cephalodorin, amphotericin B; ‘Selective GD’: nalidixic acid, co- trimoxazole, polymyxin B, neomycin, amphotericin B |
Significantly lower incidence of ≥ grade II acute GvHD in ‘complete’ GD group (P < 0.01). |
| 199213 | Retrospective analysis |
Mostly adult patients undergoing alloHSCT with HLA-identical sibling donors for aplastic anemia or leukemia (194) |
‘Sustained’ vs ‘Not sustained’ GD based on bacterial growth from stool cultures |
Gentamicin/tobramycin or netilmycin in combination with amphotericin B and nystatin. First 22 patients also received oral cephazolin solution. |
Significantly lower incidence of grade II–IV acute GvHD in patients with ‘sustained’ decontamination of anaerobic bacteria (P < 0.006). |
| 199914 | Prospective, randomized; single-center |
Mostly adult patients undergoing alloHSCT with HLA-identical sibling, mismatched family and matched unrelated donors for hematologic malignancies (134) |
Two different GD strategies (institutional standard vs additional anaerobic coverage) |
PO ciprofloxicin alone vs PO ciprofloxacin and PO metronidazole |
Significantly lower incidence of Grade II–IV acute GvHD in the metronidazole- containing arm (P < 0.0005) among recipients of transplants from HLA- matched sibling donors. No difference between the two treatment arms in recipients of mismatched family or matched unrelated donor transplants. |
| 201412 | Retrospective analysis |
Pediatric patients undergoing alloHSCT with HLA-identical sibling donors for leukemia (112) |
‘Successful’ vs ‘unsuccessful’ GD based on bacterial growth from stool cultures |
Amphotericin B and gentamicin, plus cefaloridin (1988–1993) or IV ceftriaxone and PO vancomycin (1993–1995) or PO piperacillin/ tazobactam (after 1995) |
Acute GvHD in 1 of 57 patients with ‘successful’ decontamination (grade I) and 8 of 55 patients with ‘unsuccessful’ decontamination (1 grade II, 7 grade I), P = 0.013. |
Abbreviations: alloHSCT = allogeneic hematopoietic stem cell transplantation; GD = gut decontamination; LAF = laminar air flow; PO = per os.