Dysbiosis patterns during re-induction/salvage versus induction chemotherapy for acute leukemia

Sci Rep. 2019 Apr 15;9(1):6083. doi: 10.1038/s41598-019-42652-6.


Acute leukemia (AL) patients undergoing intensive induction chemotherapy develop severe gut dysbiosis, placing them at heightened risk for infectious complications. Some AL patients will undergo "repeat therapy" (re-induction or salvage) due to persistent or relapsed disease. We hypothesized that prior injury to the microbiome during induction may influence dysbiosis patterns during repeat therapy. To test this hypothesis, we analyzed the bacterial microbiome profiles of thrice-weekly stool samples from 20 intensively treated AL patients (first induction: 13, repeat therapy: 7) by 16S rRNA sequencing. In mixed-effects modeling, repeat therapy was a significant predictor of Enterococcus expansion (P = 0.006), independently of antibiotic exposure, disease type, feeding mode, and week of chemotherapy. Bayesian analysis of longitudinal data demonstrated larger departures of microbial communities from the pre-chemotherapy baseline during repeat therapy compared to induction. This increased ecosystem instability during repeat therapy possibly impairs colonization resistance and increases vulnerability to Enterococcus outgrowth. Microbiota restoration therapies at the end of induction or before starting subsequent therapy warrant investigation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects*
  • DNA, Bacterial / isolation & purification
  • Dysbiosis / chemically induced
  • Dysbiosis / diagnosis
  • Dysbiosis / microbiology*
  • Enterococcus / genetics
  • Enterococcus / isolation & purification*
  • Feces / microbiology
  • Female
  • Gastrointestinal Microbiome / drug effects*
  • Humans
  • Induction Chemotherapy / adverse effects
  • Induction Chemotherapy / methods
  • Leukemia, Myeloid, Acute / drug therapy*
  • Longitudinal Studies
  • Male
  • Middle Aged
  • RNA, Ribosomal, 16S / genetics
  • Salvage Therapy / adverse effects
  • Salvage Therapy / methods
  • Sequence Analysis, DNA
  • Severity of Illness Index
  • Young Adult


  • DNA, Bacterial
  • RNA, Ribosomal, 16S