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Myeloma Gut Microbiome and Side Effects
Can a myeloma patient’s gut microbiome prevent side effects? Because the study linked below focuses on breast cancer patients, MM patients must take its findings with a grain of salt.
At the same time, therapy-related side effects can make life miserable for the newly diagnosed MM patient. As a long-term myeloma survivor myself, I know how dramatically side effects can impact MM survivors.
I think the information below is important enough for NDMM patients to add probiotic supplementation to their pre-habilitation regimen before undergoing induction therapy.
Can probiotics prevent or minimize chemotherapy’s adverse events?
Probiotics have shown promise in mitigating some adverse events associated with chemotherapy, though their effectiveness depends on the specific context and adverse effect being addressed. Here’s a breakdown:
Evidence for Probiotics in Chemotherapy Support:
- Reduction of Gastrointestinal Toxicities:
- Chemotherapy often causes diarrhea, nausea, and mucositis (inflammation of the digestive tract lining). Studies suggest that probiotics, especially strains like Lactobacillus and Bifidobacterium, may help:
- Prevent chemotherapy-induced diarrhea (CID): Probiotics can help maintain gut microbiota balance and improve intestinal barrier function, reducing the severity of diarrhea.
- Reduce mucositis: Probiotics might decrease inflammation and promote faster recovery of the gut lining.
- Chemotherapy often causes diarrhea, nausea, and mucositis (inflammation of the digestive tract lining). Studies suggest that probiotics, especially strains like Lactobacillus and Bifidobacterium, may help:
- Immune Support:
- Chemotherapy can weaken the immune system. Certain probiotics may modulate the immune response, helping to prevent infections or reduce their severity.
- Reduction of Systemic Inflammation:
- Some chemotherapy regimens cause systemic inflammation, leading to fatigue and other side effects. Probiotics might help reduce inflammation markers by modulating gut microbiota.
- Impact on Quality of Life:
- By alleviating gastrointestinal side effects and possibly reducing infections, probiotics may improve overall quality of life during chemotherapy.
Cautions and Considerations:
- Immunocompromised Patients:
- While generally safe, probiotics can pose risks to severely immunocompromised individuals, potentially leading to bloodstream infections or sepsis. Careful selection of strains and consultation with a healthcare provider are essential.
- Variability in Efficacy:
- Not all probiotics are the same. The strain, dose, and formulation matter significantly. Only specific strains have been studied in the context of chemotherapy, and benefits cannot be generalized.
- Interaction with Treatment:
- Probiotics should not interfere with chemotherapy drugs, but this interaction has not been thoroughly studied for all probiotic strains. Always discuss supplementation with your oncologist.
Do probiotics help your microbiome?
While this post focuses on the NDMM patients pre-habilitation and induction therapy, its important to point out that a growing number of MM studies document repeated cycles of therapies weaken the MM patient’s immune system which them weakens successive cycles of therapy and exposes the MM patient to side effects- particularly infections.
My point is that the MM patient’s gut health and therefore immune function are important for the MM survivor’s entire life. I think it is worth considering that probiotic supplementation be as important a therapy as is any type of chemotherapy regimen.
Email me at David.PeopleBeatingCancer@gmail.com with questions about your gut microbiome.
Thank you,
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
Gut Microbiome May Impact Chemotherapy-Induced Toxicities
“The composition of a patient’s gut microbiome may impact the toxicities they experience after receiving chemotherapy, according to a study published in Cancer.
Researchers found that gut microbial richness and diversity as well as certain microbial taxa were significantly associated with hematologic and gastrointestinal toxicities after chemotherapy.
The researchers analyzed stool samples from 301 patients with breast cancer who received neoadjuvant or adjuvant chemotherapy. Most patients (70.4%) received sequential anthracycline and taxane treatment, and 12.2% received dose-dense chemotherapy. Stool samples were collected before surgery in 134 cases and after surgery in 167 cases.
The researchers performed shotgun metagenomic sequencing on the samples and found that the patients had 4206 different species of bacteria.
In a multivariable analysis, high α‐diversity before chemotherapy was associated with a significantly lower risk of severe hematologic toxicity. This was true when using the Chao1 index (odds ratio [OR], 0.94; 95% CI, 0.89-0.99; P =.048), the Shannon index (OR, 0.94; 95% CI, 0.88-0.99; P =.023), and the inverse Simpson index (OR, 0.93; 95% CI, 0.87-0.98; P =.007).
High α‐diversity before chemotherapy was also associated with a significantly lower risk of neutropenia. This was true with the Chao1 index (OR, 0.94; 0.89-0.99; P =.016), the Shannon index (OR, 0.95; 95% CI, 0.90–0.99; P =.042), and the inverse Simpson index (OR, 0.94; 0.89-0.99; P =.017).
The researchers also found that abundance of phylum Campylobacterota was associated with a lower risk of severe hematologic toxicity, and abundance of phylum Firmicutes Iwas associated with a higher risk of severe hematologic toxicity.
Enrichment of phylum Firmicutes I, class Bacilli A, order Paenibacillales, phylum Firmicutes C, and class Negativicutes were all significantly associated with an increased risk of severe neutropenia. Abundance of phylum Synergistota, class Synergistia, and order Synergistales were significantly associated with a reduced risk of severe neutropenia.
There was no significant association between gut microbial taxa and severe gastrointestinal toxicity overall, but the researchers did find significant associations for severe nausea and vomiting.
High Chao1 indexes, β‐diversity, and most gut microbial taxa belonging to the Lachnospiraceae, Oscillospiraceae, and Ruminococcaceae families within class Clostridiaof phylum Firmicutes A were significantly associated with an increased risk of severe nausea and vomiting.
Based on these results, the researchers concluded that gut microbiota could be targeted to reduce chemotherapy‐related toxicity.
Nguyen SM, Tran HTT, Long J, et al. Gut microbiome in association with chemotherapy-induced toxicities among patients with breast cancer. Cancer. Published online February 6, 2024. doi:10.1002/cncr.35229
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