What question did this study set out to answer?

To determine whether early post-transplant gut microbial metabolic depletion and impaired ecological recovery predict graft-versus-host disease-free survival after allogeneic hematopoietic cell transplantation.

September 1, 2026Biology of Blood and Marrow TransplantationOpen Access

Early gut microbiome metabolites and diversity predict GVHD-free survival after allogeneic hematopoietic cell transplantation

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To determine whether early post-transplant gut microbial metabolic depletion and impaired ecological recovery predict graft-versus-host disease-free survival after allogeneic hematopoietic cell transplantation.
Conducted a prospective single-center observational cohort study of 62 patients undergoing allogeneic hematopoietic cell transplantation.
Quantified fecal short-chain fatty acids via liquid chromatography-tandem mass spectrometry and microbial diversity via 16S rRNA gene sequencing from stool collected pre-conditioning and at weeks 2 and 4.
Evaluated 24-month GVHD-free survival (absence of grade II-IV acute GVHD, moderate-severe chronic GVHD, or death) using multivariable Cox regression landmark analyses at day +15 and day +28.
Over 24 months of follow-up, 43 of 62 patients (69%) experienced GVHD-free survival failure due to acute GVHD (n=18), chronic GVHD (n=18), or non-GVHD death (n=7).
In day +15 landmark analysis, each doubling of week-2 short-chain fatty acids independently reduced failure hazard: butyrate (aHR 0.81, 95% CI 0.71–0.93; p=0.002), propionate (aHR 0.83, 95% CI 0.75–0.93; p<0.001), and acetate (aHR 0.85, 95% CI 0.74–0.97; p=0.018).
In day +28 landmark analysis, week-4 microbial diversity recovery independently improved survival, with each doubling of Simpson diversity lowering failure hazard (aHR 0.53, 95% CI 0.34–0.83; p=0.005), concordant with Shannon diversity (aHR 0.51, 95% CI 0.30–0.84; p=0.009).

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Implication

Prospective cohort study finds that early gut metabolites and microbial diversity improve GVHD-free survival in allogeneic transplant recipients, highlighting therapeutic targets.

Cite This Study

Kaundal et al. (2026) studied this question.

synapsesocial.com/papers/6aacb14c29a6f099161ef274 https://doi.org/10.1016/j.jtct.2026.09.012

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Implication

Prospective cohort study finds that early gut metabolites and microbial diversity improve GVHD-free survival in allogeneic transplant recipients, highlighting therapeutic targets.

Early gut microbiome metabolites and diversity predict GVHD-free survival after allogeneic hematopoietic cell transplantation

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Discussion

Implication

Cite This Study

Early gut microbiome metabolites and diversity predict GVHD-free survival after allogeneic hematopoietic cell transplantation

Key Points

Discussion

Implication

Cite This Study

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