[Fecal microbiota transplantation for graft-versus-host disease in children and adults: methods, clinical effects, safety].

AIM: Was to evaluate clinical efficacy, adverse events and changes in the gut microbiome after fecal microbiota transplantation (FMT) in patients with gastrointestinal (GI) form of graft-versus-host disease (GVHD). MATERIALS AND METHODS: The prospective single-center study in R.M. Gorbacheva institute included 27 patients with GI GVHD after allogeneic stem cell transplantation. 19 patients received FMT, 8 patients received placebo. Clinical scales for GI autoimmune diseases were used to evaluate response. Microbiome alterations were assessed with multiplex PCR. RESULTS: After FMT higher overall bacterial mass (р=0.00088), higher bacterial numbers ofBifidobacteriumspp. (р=0.021),Escherichia coli(р=0.049) andBacteroides fragilisgr. (р=0.000043) compared to placebo group. Also higher bacterial mass was observed in patients with clinical response (р=0.0057). The bacterial mass after procedure in non-responders was compared to the placebo group (р=0.31). Partial response of GVHD was achieved faster in the FMT group compared to placebo (median 4 days vs 48 days,p=0.014). Complete response was observed in 8 (42%), 14 (74%) and 16 (84%) at 30, 60 and 90 days respectively, while in the placebo group only 0%, 1 (13%) and 4 (50%) achieved complete response at the same time points. The incidence and severity of adverse events was comparable between FMT and the placebo group. CONCLUSION: FMT in patients with refractory GI GVHD was associated with favorable clinical outcomes and recovery in certain marker bacterial populations. Multiplex PCR can be used to assess an engraftment of a donor microbiota. FMT in GI GVHD was not associated with life-threatening adverse events, but further studies are required to validate clinical efficacy.

[Our experience with tracheotomy in the hematological patients in need of prolonged artificial lung ventilation].

The objective of the present work was to study the possibility and technical peculiarities of planned tracheotomy in the hematological patients with thrombocytopenia and coagulopathy suffering severe concomitant pathology. A total of 45 tracheotomies were performed in hematological patients during the period from 2009 till July 2012. The case histories of 32 patients were available for the retrospective analysis. At the time of surgical intervention, 81% of the patients presented with grade IV thrombocytopenia. Five of the patients (15.6%) suffered bleeding from the tracheostomic canal in the early postoperative period. In four of them, hemorhage was stopped by the placement of the hemostatic sponge. One patient had to be managed by means of cauterization . Two (6.25%) patients developed inflammation around tracheotsoma. It is concluded that thrombocytopenia and probable coagulopathy do not constitute an absolute contraindication for planned tracheostomy. However, such operation may have a favourable outcome only after preliminary transfusion, the application of cauterization, and delicate surgical intervention.

[Use of various nutritional support regimens in patients with transplanted hematopoietic stem cells].

AIM: To study the impact of modified nutritional support (NS) versus standard NS on therapy tolerability and posttransplantation in patients with oncohematological diseases. SUBJECTS AND METHODS: Fifty-three patients, who had been diagnosed as acute myeloblastic (n = 19) or acute lymphoblastic (n = 16) leukemias, lymphomas (n = 10), and other oncohematological diseases (n = 8) and had received large-dose polychemotherapy followed by hematopoietic stem cell transplantation (HSCT), were prospectively examined. The control group (n = 27) used standard NS (NS was prescribed when gastrointestinal (GI) events occurred; on day 1 after HSCT, the study group (n = 26) had modified NS added by glutamine dipeptide (0.57 g/kg/day). Energy demands were 35 kcal/kg/day; protein requirements were 1.5-1.7 g/kg/day. Artificial nutrition preparations were daily given through infusion pumps for 24 hours. In both groups, the criteria for NS discontinuation were natural assimilation of 60% of the required energy within 3 consecutive days or day 14 after HSCT when Gl function was preserved. RESULTS: The patients receiving modified NS showed reductions in the incidence and severity of mucositis (p = 0.05), a less significant decrease in the laboratory and anthropometric indicators of nutritional status (p = 0.01), and a better hospital outcome on day 100 after HSCT (p = 0.01). There were no differences in the rate and severity of acute graft-versus-host reaction (p = 0.7%) and in one-year overall survival (p = 0.7%). CONCLUSION: As compared with standard NS, modified NS enables a patient to sustain negative consequences of the conditioning regimen, HSCT in the early posttransplantation period.