• Yu Mizutani, Shinichiro Kawamoto, Michiko Takahashi, Hisayo Doi, Kumiko Wakida, Satoko Tabuchi, Masaaki Tanda, Akihiro Soga, Ruri Chijiki, Hidetomo Takakura, Koji Kawaguchi, Ako Higashime, Marika Watanabe, Hiroya Ichikawa, Sakuya Matsumoto, Rina Sakai, Hideaki Goto, Keiji Kurata, Seiji Kakiuchi, Yoshiharu Miyata, Kiyoaki Uryu, Yumiko Inui, Akihito Kitao, Kimikazu Yakushijin, Hiroshi Matsuoka, and Hironobu Minami.
• Division of Medical Oncology/Hematology, Kobe University Graduate School of Medicine and Hospital, Japan.
• Intern. Med. 2023 Oct 15; 62 (20): 294929582949-2958.

AbstractObjective High-dose chemotherapy with autologous hematopoietic stem cell transplantation (auto-HSCT) is an effective treatment option for relapsed and refractory aggressive malignant lymphoma. However, patients frequently experience treatment-induced gastrointestinal symptoms. Synbiotics, including live microorganisms and nondigestible food ingredients, reportedly ameliorate chemotherapy-induced mucosal damage. In this study, we assessed the efficacy and safety of synbiotics in patients undergoing auto-HSCT. Methods This randomized, double-blinded study included patients with malignant lymphoma eligible for auto-HSCT. The patients were randomly assigned to either a synbiotic group receiving Bifidobacterium longum (BB536) and guar gum or a placebo group receiving a placebo containing dextrin. The supplements were administered twice daily from the start of conditioning chemotherapy up to 28 days after auto-HSCT. The primary endpoint was the duration of total parenteral nutrition (TPN). Results In total, 12 patients were included and randomized. The median duration of TPN was 15 (range, 12-33) days in the synbiotic group and 17.5 (range, 0-32) days in the placebo group. The median duration of grade ≥3 diarrhea was shorter in the synbiotic group than in then placebo group (2.5 vs. 6.5 days), as was the duration of hospital stay (31.5 vs. 43 days). The oral intake and quality of life regarding diarrhea and anorexia improved in the synbiotic group after engraftment. Synbiotic infections, including bacteremia, were not observed. Conclusion Synbiotics may reduce gastrointestinal toxicity, thereby reducing nutritional problems and improving the quality of life of patients undergoing auto-HSCT, without severe adverse events.

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