Table 1.

Proposed next steps for future research investigating the microbiome-host relationship in HCT patients

Primary Research Gaps and Strategies

Multi-institutional prospective studies to improve generalizability of microbiota research findings Multi-center biospecimen and data collection to support collaborative and integrative “multi-omic” approaches to microbiota research Expansion of microbial metagenomic studies in HCT patients beyond bacterial taxonomy Investigation of the role of the virome and mycobiome in HCT outcomes Elucidation of microbial genes and metabolic pathways that impact outcomes, in particular the antibiotic resistome Targeting of specific microbes and/or microbial pathways to determine whether modification of the microbiota can impact microbe-disease associations Investigation of the role of extra-intestinal microbial populations (i.e. oral, skin, vaginal, eye) in the development of acute and chronic GVHD Investigation of microbial-host dynamics associated with the development of chronic GVHD and other non-GVHD outcomes Modification of antibiotic strategies that balance preservation and restoration of the microbiome with appropriate infection prevention and treatment Antibiotic-sparing approaches to infection prevention and treatment; steroid-sparing approaches to GVHD prevention and treatment Incorporation of standardized antibiotic and infection-related data into national transplant databases Understanding the potential for using the microbiome as a biomarker for transplant outcomes and as a guide to interventions