If you are a candidate for a bone marrow transplant, or BMT, your doctor might discuss the use of probiotics. There is currently no formal consensus among transplant centers concerning the use of probiotics in BMT, but some centers do use them in certain situations. While being treated with a BMT, you should never take probiotics or any other supplement without consulting your BMT team.
Probiotics
Probiotics are microorganisms or germs that are similar or identical to the germs found in the human gut. Most probiotics are usually bacteria, such as Lactobacillus or Bifidobacterium, or yeast, such as Saccharomyces. These are usually called "good bacteria" or "good germs." Probiotics usually are found in dietary supplements or foods, such as yogurt. According to the National Center for Complementary and Alternative Medicine, there is good evidence to support the use of probiotics to treat diarrhea caused by rotovirus and C. dificile, but little scientific evidence to support their use for other reasons.
Transplant Facts
When undergoing a bone marrow transplant, also known as a stem cell transplant, you will be given chemotherapy or radiation or both to destroy your bone marrow, which will leave you with a very poorly functioning immune system. This condition is called immunosuppression and puts you at risk for infections, some of which might even be life-threatening. In this situation, germs of any kind can be dangerous. In addition, radiation and chemotherapy can damage the lining of your gut, making it easier for germs to enter the bloodstream from your intestines. Another complication of transplant is something called graft-versus-host disease, or GVHD, in which the transplanted cells, the graft, start attacking your body, the host. GVHD can cause problems with the gut, skin, liver, and other organs.
Benefits
During the transplant process, you will be given a variety of potent antibiotics to help fight infection. Some of these will destroy the normal, good germs in your gut and can lead to diarrhea and even more infections with other germs, such as C.dificlile. In this case, some transplant centers might use probiotics to restore your normal gut germs to fight the diarrhea or gut infections, though there is no definitive study to support this therapy. One study published in the journal "Blood" in 2004 showed that the use of probiotics in transplant patients reduces the risk of GVHD, but that study has not been repeated.
Risks
According to Karen Kiley, nurse practitioner with the BMT Team at Loyola University Medical Center, because of immunosuppression and the damage to the lining of the gut during transplant, some doctors are afraid of introducing any germs to the patient, even the "good germs" of probiotics. There have been reports of transplant patients getting severe blood infections with Lactobacillus and Saccharomyces, even though these patients weren't given any probiotics.
Consensus
There is no definitive consensus on the use of probiotics in bone marrow transplants. If you are a transplant candidate and are curious about probiotics, speak with your doctor or transplant team to discuss the risks and benefits of probiotics.
Future
Because there is no consensus, there are at least two clinical trials underway aimed at determining the safety and efficacy of probiotics in BMT. The studies, including one for children and one for adults, began in 2009 and are actively recruiting participants. The resource section below lists the websites for these studies.
References
- Thompson J, Duffy J. Nutrition support challenges in HSCT patients. Nutrition In Clinical Practice (2004) 23(5):533-46
- US National Institutes of Health: National Center for Complementary and Alternative Medicine: An Introduction to Probiotics
- BMT Infonet: During Transplant
- Bobak D, Arfons LM, Creger RJ, Lazarus HM. C. Dificle-associated disease in human SCT recipients. Bone Marrow Tranplantation (2008) 42, 705-713
- Gerbitz A, Schultz M, Wilke A, Linde HJ, Scholmerich J, Reinhard A, Holler E. Probiotic effects on experimental GVHD: let them eat yogurt. Blood (2004) 103:4365-4367
- Karen Kiley, RN, NP, BMT Team, Loyola University Medical Center, Maywood, IL: Phone interview 11/17/10
