Probiotic Supplementation Decreases Chemotherapy-induced Gastrointestinal Side Effects in Patients With Acute Leukemia

Abstract

Introduction: In children with acute leukemia, gut microbiota is modified secondary to chemotherapy administration, leading to gastrointestinal side effects. Probiotics are microorganisms that can restore gut microbiota and may help alleviate gastrointestinal symptoms. The aim of this pilot study was to assess the effects of probiotic supplementation on chemotherapy-induced gastrointestinal side effects in children with acute leukemia (AL). Methods: In this randomized pilot study, patients under 17 years of age diagnosed with AL who were on remission induction or remission reinduction chemotherapy were randomly assigned to receive probiotic supplementation (a concentration of 5×109 CFU per sachet was administered at a standard dose twice daily, by mouth) or no probiotic supplementation. The primary endpoint was the prevalence of gastrointestinal side effects. Vomiting, nausea, flatulence, dyspepsia, diarrhea, constipation, abdominal pain, and abdominal distention were assessed in both groups. Results: Gastrointestinal side effects were less prevalent in the probiotic group, and 3 of the 8 gastrointestinal side effects (nausea, vomiting, and abdominal distension) significantly decreased in the probiotic group (P<0.05). We found for diarrhea a relative risk of 0.5 (95% confidence interval [CI], 0.2-1.2; P=0.04); for nausea an RR of 0.5 (95% CI, 0.4-0.8; P=0.04) and for vomiting an RR of 0.4 (95% CI, 0.2-0.9; P=0.04). Conclusions: Daily supplementation with Lactobacillus rhamnosus reduced chemotherapy-induced gastrointestinal side effects in children with AL.

Intestinal Microbiota: A Novel Target to Improve Anti-Tumor Treatment?

“…In conclusion, following treatment, a decrease in microbiota diversity and richness, as well as dysbiosis, could exacerbate severe side effect in murine models of cancer and in cancer patients [23,24,25,26,27,28]. This hypothesis has been reinforced by recent studies showing that microbiome modulation through alimentation or probiotic supplementation could reduce the chemotherapy toxicity and subsequent side effects in mice and humans (see below) [17,29,30,31].…”

The microbiome role in pathogenesis of inflammatory and immune alterations of gastrointestinal tract in pediatric patients with cancer

“…J. Reyna Figueroa и соавт. получили данные о безопасности применения пробиотиков Lactobacillus rhamnosus у детей на этапе терапии индукции и реиндукции острого лимфобласт ного и миелобластного лейкозов [55]. Эффективность такого лечения была продемонстрирована в виде уменьшения эпизодов тошноты, рвоты, вздутия жи вота, метеоризма, запоров и диареи в группе больных, получавших пробиотики [55].…”

Clinical effects and applications of the gut microbiome in hematologic malignancies

“…Microbiota‐based approaches to mitigating the toxicity of therapy in ALL are also being developed. Reyna‐Figueroa et al 22 performed a small randomized trial of oral Lactobacillus rhamnosus supplementation, a common probiotic, in pediatric ALL and acute myeloid leukemia (AML) patients receiving chemotherapy. They evaluated its impact on chemotherapy‐related gastrointestinal toxicity and found reductions in diarrhea, nausea, and vomiting.…”

“…1). 11 Probiotics have been explored as a means to minimize chemotherapy‐related toxicities of the gastrointestinal tract or mouth, as discussed previously, but they may be limited by the risk of bacteremia in immunocompromised patients 22,56 . Prebiotics are nutritional supplements such as dietary fibers that work to nourish existing gut bacterial populations whose presence is felt to confer health benefits 76 .…”