title: The role of the gastrointestinal microbiome in infectious complications during induction chemotherapy for acute myeloid leukemia.
abstract: Despite increasing data on the impact of the microbiome on cancer, the dynamics and role of the microbiome in infection during therapy for acute myelogenous leukemia (AML) are unknown. Therefore, the authors sought to determine correlations between microbiome composition and infectious outcomes in patients with AML who were receiving induction chemotherapy (IC).
  
  
  
  Buccal and fecal specimens (478 samples) were collected twice weekly from 34 patients with AML who were undergoing IC. Oral and stool microbiomes were characterized by 16S ribosomal RNA V4 sequencing using an Illumina MiSeq system. Microbial diversity and genera composition were associated with clinical outcomes.
  
  
  
  Baseline stool α-diversity was significantly lower in patients who developed infections during IC compared with those who did not (P = .047). Significant decreases in both oral and stool microbial α-diversity were observed over the course of IC, with a linear correlation between α-diversity change at the 2 sites (P = .02). Loss of both oral and stool α-diversity was associated significantly with the receipt of a carbapenem P < 0.001. Domination events by the majority of genera were transient (median duration, 1 sample), whereas the number of domination events by pathogenic genera increased significantly over the course of IC (P = .002). Moreover, patients who lost microbial diversity over the course of IC were significantly more likely to contract a microbiologically documented infection within the 90 days after IC neutrophil recovery (P = .04).
  
  
  
  The current data present the largest longitudinal analyses to date of oral and stool microbiomes in patients with AML and suggest that microbiome measurements could assist with the mitigation of infectious complications of AML therapy. Cancer 2016;122:2186-96. © 2016 American Cancer Society.
authors.affiliation: Department of Infectious Disease, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Jessica R
authors.initials: JR
authors.lastname: Galloway-Peña
authors.affiliation: The Alkek Center for Metagenomics and Microbiome Research, Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Smith
authors.affiliation: Department of Infectious Disease, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Pranoti
authors.initials: P
authors.lastname: Sahasrabhojane
authors.affiliation: The Alkek Center for Metagenomics and Microbiome Research, Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas.
authors.forename: Nadim J
authors.initials: NJ
authors.lastname: Ajami
authors.affiliation: Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas.|Department of Statistics, Rice University, Houston, Texas.
authors.forename: W Duncan
authors.initials: WD
authors.lastname: Wadsworth
authors.affiliation: Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Naval G
authors.initials: NG
authors.lastname: Daver
authors.affiliation: Department of Infectious Disease, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Roy F
authors.initials: RF
authors.lastname: Chemaly
authors.affiliation: Department of Infectious Disease, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Lisa
authors.initials: L
authors.lastname: Marsh
authors.affiliation: Department of Infectious Disease, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Shashank S
authors.initials: SS
authors.lastname: Ghantoji
authors.affiliation: Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Naveen
authors.initials: N
authors.lastname: Pemmaraju
authors.affiliation: Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Garcia-Manero
authors.affiliation: Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Katayoun
authors.initials: K
authors.lastname: Rezvani
authors.affiliation: Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Amin M
authors.initials: AM
authors.lastname: Alousi
authors.affiliation: Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.|Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Wargo
authors.affiliation: Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Shpall
authors.affiliation: Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Phillip A
authors.initials: PA
authors.lastname: Futreal
authors.affiliation: Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Michele
authors.initials: M
authors.lastname: Guindani
authors.affiliation: The Alkek Center for Metagenomics and Microbiome Research, Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas.
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Petrosino
authors.affiliation: Department of Infectious Disease, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Dimitrios P
authors.initials: DP
authors.lastname: Kontoyiannis
authors.affiliation: Department of Infectious Disease, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas.|Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Samuel A
authors.initials: SA
authors.lastname: Shelburne
mesh_terms: D000328:Adult; D000368:Aged; D044822:Biodiversity; D005260:Female; D000069196:Gastrointestinal Microbiome; D059014:High-Throughput Nucleotide Sequencing; D006801:Humans; D060828:Induction Chemotherapy / Q000009:adverse effects*; D007239:Infections / Q000175:diagnosis / Q000209:etiology*; D015470:Leukemia, Myeloid, Acute / Q000150:complications* / Q000188:drug therapy; D008297:Male; D054892:Metagenome; D056186:Metagenomics / Q000379:methods; D008875:Middle Aged; D011379:Prognosis; D012336:RNA, Ribosomal, 16S / Q000235:genetics; D055815:Young Adult
chemical_list: D012336:RNA, Ribosomal, 16S
keywords: acute myeloid leukemia; gastrointestinal; induction chemotherapy; infectious complications; microbiome