A simple transplant of gut microbes from a healthy donor could help blood cancer patients survive their stem cell treatment with fewer fevers, fewer days in hospital, and no intensive care admissions. This matters because blood cancer patients often become carriers of antibiotic-resistant bacteria in their gut. Standard antibiotics cannot kill these pathogens, and the resulting bloodstream infections are severe and hard to treat. The problem is driven by the very antibiotics and chemotherapy patients need to survive. Early, uncontrolled observations by the research team suggest that transplanting healthy gut microbes before a bone marrow transplant may restore the gut’s natural ability to block these resistant bacteria, while also improving the patient’s overall response to cancer treatment. If a randomised placebo-controlled trial confirms these benefits, the approach could transform a routine but risky part of blood cancer care. Patients would need fewer antibiotics, spend less time in hospital, and have a higher chance of long-term transplant success—without requiring new drugs or expensive equipment. The impact would be felt directly by patients and their families, and indirectly by reducing pressure on intensive care units and limiting the spread of antibiotic-resistant bacteria in hospital settings.
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The microbes which inhabit our gut play a pivotal role in our health, influencing the immune system, response of a patient to drugs and progression of many diseases. Blood cancer patients frequently become colonised with (or 'carriers' for) bacteria in different areas of the body (including their gut lining) that are resistant to nearly all the known antibiotics that we have; these bacteria can enter the bloodstream and cause severe infections that are hard to treat. This situation arises because these patients are frequently prescribed antibiotics to control and treat infections, as well as because of the chemotherapy they receive. In healthy individuals, the many health-associated gut microbes we have can protect against colonisation by antibiotic resistant bacteria , but this function is severely compromised in blood cancer patients due to the many courses of antibiotics that they have received during their disease. Since the antibiotics that we have cannot kill these pathogens in the cancer patients, we developed an alternative treatment that transplants the gut microbes from healthy individuals into the intestines of blood cancer patients who are colonised with antibiotic resistant bacteria. When we undertook this procedure, our primary goal was to control the number of antibiotic resistant bacteria. However, the haematologists also unexpectedly noticed that their patients were responding to their bone marrow transplant treatment better than the patients who had not received gut microbes transplantation. We found that the blood cancer patients who had received a gut microbes transplantation were less likely to need further antibiotics during treatment. Furthermore, none of them were admitted to intensive care, they had fewer days in hospital, fewer cases of fever, and better long-term success of their stem cell transplant. These changes in their response to the bone marrow transplant spurred us to consider whether a gut microbes transplantation in patients with leukaemia before they receive their bone marrow transplant will improve the patient's journey during treatment for their cancer. To test this idea further, we will conduct a randomised placebo-controlled clinical trial. We will randomise blood cancer patients to receive either a capsule containing gut microbes from a healthy donor or a placebo capsule before they receive their bone marrow transplant. We will compare the diversity (degree of mixture) of the microbes in their gut, between the two groups over time, as low gut microbe diversity has been shown to predict blood cancer patients having more problems after their stem cell transplant. We will also compare how patients in each group respond to their treatment, any safety issues, and whether any extra treatment or care is required.
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