PracticeUpdate Conference Series ASH 2018

that it is possible to predict outcomes pre-transplant, said Dr. Peled. “The impli- cation is that if we come up with a way to remediate microbiome injury, there might be time to implement it before the transplant.” What could be done to treat the microbi- ome before transplantation? According to Dr. Peled, strategies could include the use of probiotics, or a prebiotic approach in which patients are given food that promotes growth of beneficial bacteria. Alternatively, a postbiotic approach could be used that emphasizes the use of short- chain fatty acids and indole derivatives, and avoids foods that compromise the mucus barrier. “And we could think about a different anti- biotic strategy; to use or not use different kinds of antibiotics in a rational way," he said. "The bottom line is that these are different strategies that are in develop- ment. This is where many fields are going, and we are trying to take bone marrow transplantation in this direction, as well.”

In an interview with Elsevier’s PracticeUpdate , Dr. Peled emphasized the importance of collaboration with multiple sites in studies like this. For example, the fact that microbiota injury, and the association of diversity with overall survival, was prevalent across geography “is significant because it sug- gests that associations that are made in one center are probably applicable across geography, even though there are differences in clinical practice from center to center, and there are geographical dif- ferences in the natural history of the gut microbiota around the world.” “A lot of correlative research is done in retrospective, observational single-center studies, and we’ve certainly engaged in our share of those,” Dr. Peled added. “But I think it’s time for our field to move beyond that and do multicenter studies with central analysis of specimens. That’s a way to get over the batch effects and the biases that can be introduced with single-center studies.”

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ASH 2018 • PRACTICEUPDATE CONFERENCE SERIES