Table II.

Summary of microbiota-oriented approaches to mitigate infectious complications in acute leukemia patients treated with intensive chemotherapy

Approach	Concept	Advantages	Challenges
Antibiotic stewardship	Minimize antibiotic exposure by rapid de-escalation and/or discontinuation	Simple intervention Numerous supportive clinical trials in patient setting	Unknown best timing Lack of reliable biomarkers to assure safety Unclear best clinical endpoint Possible reluctance amongst clinicians
Nonselective luminal adsorbents	Adsorb the luminal fraction of antibiotics and prevent exposure of microbiota	Simple intervention	Adsorption of critical nonantibiotic drugs Difficult to implement during chemotherapy No published data in patient setting
Selective luminal antibiotic degraders	Degrade the luminal fraction of antibiotics and prevent exposure of microbiota	Simple intervention Encouraging efficacy in patient setting (respiratory tract infection)	Degraders of most antibiotic classes are not available
Prebiotics	Help the beneficial microbes by stimulating their growth	Simple intervention High likelihood of safety	Questionable history of efficacy May not fix large microbiota injuries No published data supporting efficacy in patient setting
Probiotics	Restore a critical component of the microbiota	Simple intervention Commercial products available Safety data in patient setting	May not fix large microbiota injuries Risk of microbial translocation Minimal published data supporting efficacy in patient setting
Fecal microbiota transplantation	Restore entire microbial community	Comprehensive microbiota restoration Strong clinical efficacy (C. difficile infection)	Risk of microbial translocation Unknown effects of a new microbial community in a new host (ie, microbiota-host “mismatch”) Donor involvement in allogeneic products Technical challenges in production, storage, and administration Limitation of autologous products in patient settings because of possible baseline alterations