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Fecal Microbiota Transplantation / Fecal Filtrate Transplantation / Hematologic Neoplasms · Journal article
Gut Microbes · August 24, 2026
Early or partial results. Treat as a signal, not a conclusion.
This prospective pilot case series documents clinical feasibility and rapid sustained resolution of fulminant CDI in three aplastic hematologic patients treated with fecal filtrate transplantation (FFT) as salvage therapy after failure of standard antimicrobials. All three achieved clinical cure by day +14 with good tolerability, though one died of unrelated infection by day +30 and the mechanism of benefit remains unclear. The study is too small and uncontrolled to establish efficacy or guide clinical practice, but suggests the intervention warrants further investigation.
Single-center, prospective, protocol-defined pilot case series. Adult patients with hematologic malignancies, chemotherapy-induced grade-4 aplasia, and fulminant CDI refractory to ≥5 days of high-dose antimicrobial therapy (vancomycin, metronidazole, tigecycline). All three enrolled patients had adverse-risk acute myeloid leukemia. Enrolled at South Pest Centra…. Intervention: Fecal filtrate transplantation (FFT) prepared from a single unrelated donor using sequential centrifugation and filtration, administered via nasogastric tube in two doses. n = 3. Single center: South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Budapest, Hungary.
All 3 patients achieved clinical resolution of CDI by day +14 post-FFT, accompanied by improvements in abdominal distension and inflammatory markers By day +30, 2 of 3 patients maintained remission with confirmatory follow-up; 1 died from Pseudomonas aeruginosa septic shock (unrelated cause) FFT was well tolerated with no procedure-related immediate complications or FFT-attributable adverse events reported
Very small sample (n=3) provides no reliable estimate of true response rate, adverse event frequency, or safety profile One patient died by day +30, but cause was attributed to unrelated Pseudomonas aeruginosa infection rather than CDI relapse or FFT; unclear whether FFT contributed to immunosuppression or infection risk
The rapid and sustained CDI resolution observed in all three heavily pretreated aplastic patients suggests FFT may offer a rescue option for this high-mortality scenario. However, clinicians should recognize this is a feasibility report from three patients without a control group; the mechanism of benefit is unclear, and whether the benefit persists beyond day +30 or generalizes to other populations remains unknown.
Single-center pilot case series of n=3 with no comparator; demonstrates feasibility and clinical signal in a high-risk population but requires confirmation in larger controlled studies before informing practice.
As stated by the source record.
Quoted from the source exactly as published.
The rapid and sustained CDI resolution observed in all three heavily pretreated aplastic patients suggests FFT may offer a rescue option for this high-mortality scenario. However, clinicians should recognize this is a feasibility report from three patients without a control group; the mechanism of benefit is unclear, and whether the benefit persists beyond day +30 or generalizes to other populations remains unknown.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Background. Fulminant Clostridioides difficile infection (CDI) in patients with hematologic malignancies during chemotherapy-induced aplasia carries high mortality and limited treatment options. Our objective was to evaluate fecal filtrate transplantation (FFT) as a salvage therapy for fulminant CDI during aplasia, and to explore whether donor-recipient phage dynamics may contribute to clinical response.Methods. We conducted a single-center, prospective, protocol-defined pilot case series study including consecutive adults with hematologic malignancies, chemotherapy-induced grade-4 aplasia and fulminant CDI, refractory to ≥5 d of high-dose oral vancomycin plus intravenous metronidazole and tigecycline. FFT was prepared from a single unrelated donor using sequential centrifugation and filtration, and administered via nasogastric tube in two doses. The primary outcome was sustained clinical cure, secondary outcomes included survival and adverse events, assessed at +14 and +30 d post-FFT. 16S rRNA gene sequencing was used to assess microbiome compositions, while viral metagenomics and in vitro propagation assays were employed to characterize donor-recipient phageome interactions.Results. Three patients with adverse-risk acute myeloid leukemia and fulminant CDI caused by genetically distinct C. difficile strains received FFT. All patients achieved clinical resolution by day +14, accompanied by improvements in abdominal distension and inflammatory markers. By day +30, one patient died from Pseudomonas aeruginosa septic shock, while two maintained remission with confirmatory follow-up. FFT was well tolerated, with no procedure-related immediate complications or FFT-attributable adverse events. Microbiome and phage profiling revealed heterogeneous responses, including shifts in bacterial community composition, with no clear evidence for a general role of donor-derived phages in CDI resolution. In contrast, we observed induction of prophages harbored by recipient-associated Clostridium species, which may have contributed to decolonization through stress-induced entry into the lytic cycle.Conclusions. FFT was feasible, with rapid sustained CDI resolution in hematologic patients with chemotherapy-induced aplasia.Trial registration. ClinicalTrials.gov identifier NCT07172191.Summary. Prospective single-center pilot study of fecal filtrate transplantation (FFT) for fulminant-refractory C. difficile infection in three aplastic adult hematologic patients. FFT was well tolerated, achieved rapid clinical cure, and showed heterogeneous microbiome and phageome modulation, potentially contributing to therapeutic effects.
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