Breast milk consumption during bone marrow transplant benefits infants, young children
SALT LAKE CITY — Consuming human milk modified the intestinal microbiome and appeared associated with reduced inflammation and graft-versus-host disease among children aged younger than 5 years who underwent hematopoietic stem cell transplantation, according to results presented at the BMT Tandem Meetings.
“After contemplating the properties of human milk as the first prebiotic and with emerging data on how the microbiome is altered in acute GVHD, we decided to do a study where 66% of children up to the age of 5 years would be offered human milk and the remaining 33% would be fed standard formula,” Pooja Khandelwal, MD, member of the division of bone marrow transplantation and immune deficiency at Cincinnati Children’s Hospital Medical Center and assistant professor at University of Cincinnati Department of Pediatrics, told HemOnc Today. “We then wanted to compare these two groups to see if there were any differences in transplant outcomes, specifically, acute GVHD and opportunistic infections.”
Khandelwal and colleagues randomly assigned children aged 0 to 5 years 2:1 to receive either donor human breast milk (n = 23) formulated for the study or standard feeding formula (n = 10).
Children who were breastfeeding at the time of HSCT (n = 9) were automatically assigned to the human milk cohort. Both arms were monitored by a dietician.
Human milk diet began 3 days before transplant and continued until 14 days after transplant.
Follow-up for GVHD and blood stream infections occurred 100 days after transplant. Researchers assessed patients’ microbiome at enrollment and 14 days after transplant.
Four controls withdrew from the study and two controls obtained human milk from alternate sources and, therefore, could not be included in study analyses.
Twenty-four patients received at least 60% of total goal breast milk and were available for study.
Patients who received human milk had decreased cytokines including IL-6 (P = .04), IL-8 (P = .04), IL-10 (P = .004), IFNg (P = .04) and soluble IL2 receptor (P = .08) compared with controls. “I was also surprised by the reduction in inflammatory cytokines, reduction in Reg 3alpha — a marker of intestinal injury — and the T-cell activation, which was lower in children who received breast milk,” Khandelwal said. “I hadn’t anticipated that human milk would have effects beyond changing the intestinal microbiome.”
The human milk cohort also showed a decrease in Streptococcus spp. abundance 14 days after transplant compared with controls (P = .04).
Four children in the human milk cohort developed GVHD compared with three controls (P = .04). The milk cohort also showed fewer blood stream infections (3 per 100 line days vs. 9 per 100 line days).
“Oftentimes, in children undergoing bone marrow transplant, breastfeeding is considered a risk factor for transmission of cytomegalovirus,” Khandelwal said. “This was not our observation on our study, so until we further understand the far-reaching benefits of human milk in the post-bone marrow transplant setting, I would encourage clinicians to not prevent mothers from breastfeeding their children even while undergoing a bone marrow transplant.”
Additionally, Khandelwal expressed a need for future research in this area: “We need to do a larger scale study to replicate our current observations in a larger independent cohort of patients. We also do not know if human milk should be continued beyond 14 days after bone marrow transplant,” she said. – by Cassie Homer
Khandelwal P, et al. Abstract 83. Presented at: BMT Tandem Meetings; Feb. 21-25, 2018; Salt Lake City.
Disclosures: The authors report no relevant financial disclosures.