Gut microbiome in pediatric acute leukemia: from predisposition to cure

The gut microbiome (GM) has emerged as a key factor in the genesis and progression of many diseases. The intestinal bacterial composition also influences treatment-related side effects and even the efficacy of oncological therapies. Acute leukemia (AL) is the most com-mon cancer among children and the most frequent cause of cancer-related death during child-hood. Outcomes have improved considerably over the past 4 decades, with the current long-term survival for acute lymphoblastic leukemia being-90%. However, several acute toxicities and long-term sequelae are associated with the multimodal therapy protocols applied in these patients. Specific GM configurations could contribute to the multistep developmental hypothe-sis for leukemogenesis. Moreover, GM alterations occur during the AL therapeutic course and are associated with treatment-related complications, especially during hematopoietic stem cell transplantation. The GM perturbation could last even after the removal of microbiome-modifying factors, like antibiotics, chemotherapeutic drugs, or alloimmune reactions, contrib-uting to several health-related issues in AL survivors. The purpose of this article is to provide a comprehensive review of the chronological changes of GM in children with AL, from predis-position to cure. The underpinning biological processes and the potential interventions to modulate the GM toward a potentially health-promoting configuration are also highlighted.

Automated summary

The gut microbiome plays a crucial role in the development and progression of diseases, affecting treatment outcomes and complications in acute leukemia patients. Specific gut microbiome configurations may contribute to leukemogenesis, and alterations during therapy could lead to long-term health issues in survivors. This article reviews chronological changes in the gut microbiome of children with acute leukemia and highlights potential interventions to promote health.