Figure 3. Microbiota Injury before HCT and Association with Transplantation Outcomes.

The diversity of the initial pretransplantation samples from patients (obtained on day −30 to −6) is lower than the diversity of 313 samples from 212 participants of the Human Microbiome Project (HMP) and 1 sample obtained from each of 34 healthy adult volunteers at MSK (healthy controls) (Panel A). A total of 993 patients were included in the analysis at MSK, 95 at Duke, 40 at Regensburg, and 45 at Hokkaido. The horizontal line in each box represents the median, the lower and upper boundaries of the boxes the interquartile range, the ends of the whisker lines the minimum and maximum values within 1.5 times the interquartile range, and the dots the individual data points. The proportions of samples from healthy volunteers and initial samples from patients that could be classified according to the enterotype scheme are plotted (Panel B). Samples obtained before HCT were less likely to be classified as belonging to an enterotype than were samples obtained from healthy volunteers. In cohort 1, overall survival was longer among patients with higher intestinal diversity in the initial samples than among those with lower diversity (Panel C). There were 72 deaths among 250 patients in the higher-diversity group and 101 deaths among 251 patients in the lower-diversity group (Table S7). Tick marks indicate censored data. Combined analyses of diversity before transplantation and during the periengraftment period are shown in Table S8 and Figure S7.