Safety and Efficacy of Fecal Microbiota Transplantation to Treat and Prevent Recurrent Clostridioides difficile in Cancer Patients

Authors

Hiba Ali
Shruti Khurana
Weijie Ma
Yuanzun Peng
Zhi-Dong Jiang
Herbert DuPont
Hao Chi Zhang
Anusha S Thomas
Pablo Okhuysen
Yinghong Wang

Publication Date

1-1-2021

Journal

Journal of Cancer

DOI

10.7150/jca.59251

PMID

34659541

PMCID

PMC8489149

PubMedCentral® Posted Date

9-7-2021

PubMedCentral® Full Text Version

Post-Print

Published Open-Access

yes

Keywords

Recurrent Clostridioides difficile infection, fecal microbiota transplantation, FMT, cancer, malignancy

Abstract

Background: Cancer patients are at increased risk of recurrent Clostridioides difficile infection (rCDI) due to malignancy itself, cancer therapy, and frequent antibiotic use and have a lower response rate to standard oral antibiotics. There are limited data on the safety and efficacy of fecal microbiota transplantation (FMT) for treating rCDI in cancer patients. We aim to describe our experience of using FMT to treat rCDI at a tertiary cancer center.

Methods: We conducted a retrospective study of cancer patients who underwent FMT for rCDI at The University of Texas MD Anderson Cancer Center from June 2017 through January 2020. Baseline clinical data and risk factors related to rCDI and FMT were evaluated and compared between cancer types and between cases with remission and recurrence.

Results: A total of 19 patients were studied: 12 with solid malignancies and 7 with hematologic malignancies. Most patients had stage IV cancer, and 21% of patients were in cancer remission. On average, patients had 2 episodes of CDI and received 3 courses of antibiotics within 1 year before FMT. 84% of patients with rCDI responded to FMT. Compared with patients who had CDI remission following FMT, non-remission cases were more likely to have received antibiotics following FMT. There were no serious adverse events or mortality within 30 days associated with FMT.

Conclusions: FMT is safe, well-tolerated, and efficacious in treating rCDI in selected cancer patients. However, additional antibiotic use for complications from chemotherapy or immunosuppression negatively affected the efficacy of FMT in this population with advanced cancer.

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