Dietary Intervention Presentations Promise in Blood Cancers

SAN DIEGO — Increased dietary fiber had a indispensable association with improved outcomes in blood cancers, per analyze reported right here.

Patients undergoing allogeneic hematopoietic cell transplant (allo-HCT) had drastically better survival and a decrease rate of graft-versus-host illness (GVHD) with better ranges of fiber consumption. The outcomes were related to adjustments in biomarkers linked to better outcomes. A second peer confirmed boost in biomarkers linked to development of smoldering myeloma to the frank illness declare in patients who consumed a plant-basically based utterly, fiber-rich weight reduction map. Both learn were bolstered by laboratory data per the clinical findings, as reported on the American Society of Hematology annual meeting.

“When any individual is facing a prognosis of most cancers or some different blood dysfunction, the emotional response to that is to demand, ‘What did I fabricate to be on this scenario’ or ‘What can I fabricate to solve this scenario,'” acknowledged Chancellor Donald, MD, of Tulane University College of Remedy in New Orleans, and moderator of a press briefing that incorporated the fiber learn. “One of many issues we have now the supreme retain watch over over is our total lifestyle and weight reduction map. This learn speaks actual now to the premise of ​​lifestyle modification as you face different concerns.”

The make-up of intestine microbiota can affect outcomes in allo-HCT. Old learn have shown that excessive microbial vary, excessive butyrate production, and a low abundance of Enterococci are related to improved total survival (OS) after allo-HCT, acknowledged Jenny Paredes, PhD, of City of Hope National Scientific Center, in Duarte, California.

Dietary fiber promotes microbial boost, production of quick-chain fatty acids (butyrate and acetate), and epithelial homeostasis, while cutting back the abundance of opportunistic pathogens (akin to Enterobacteriaceae ) and pro-inflammatory effector Th1 cells, she endured. Collectively, the evidence supported the hypothesis that dietary fiber increases microbial vary and relative abundance of butyrate producers, which will cleave GVHD severity.

Dietary Fiber and Transplantation

Investigators amassed dietary knowledge of 173 patients who underwent allo-HCT. The information incorporated 35,228 meals and 3,837 days of tracking, corrected for consumed parts and dry grams per nutrient. They separated fiber consumption from varied nutritional groups and extra dissected fiber into essentially the most frequent sorts. The resulting data were archaic to build cohorts of excessive and low fiber consumption.

The subsequent analyses confirmed that fiber consumption had a obvious correlation with Blautia (a butyrate producer) and detrimental correlation with Enterococcus. Paredes and colleagues moreover learned a obvious correlation between excessive fiber consumption (as assessed on day 12 after allo-HCT) and OS (P =0.045) out to 24 months.

To peep associations between fiber consumption and GVHD outcomes, investigators examined 101 non-T cell-depleted patients, and identified 29 who developed decrease gastrointestinal (GI) GVHD and 29 who did not. They obtained more than 100 samples of puny-chain fatty acids from both groups. Analyses confirmed that high fiber consumption was as soon as related to increased microbiome α-vary (P =0.007) and β-vary (P <0.001) in patients with decrease GI-GVHD.

Additionally, fecal butyrate (P <0.001) and acetate (P <0.001) concentrations were reduced in association with low fiber intake in the lower GI-GVHD group and were lower in the GVHD versus non-GVHD groups (P =0.007, P = 0.008). Finally, the investigators found that high fiber intake had a significant negative association with acute GVHD incidence (P =0.034).

For validation of the findings, Paredes and colleagues examined varying dietary fiber intake in pre-clinical models of GVHD. They feed laboratory animals diets that contain 0%, 6%, or 12% cellulose. The highest fiber intake was associated with better GVHD survival. Increasing fiber intake was associated with greater microbial diversity (P =0.001) and butyrate production (P =0.065) and reduced abundance of enterococcus ( P =0.044).

Other favorable effects of the 12% cellulose diet included increased gene expression related to epithelial homeostasis, cecal butyrate, and ratio of regulatory T cells, reduced T cell-mediated inflammation, and prevention of gut barrier damage.

In response to a question, Paredes said investigators controlled for antibiotic use and type of conditioning regimen but not the indication for transplant and other potential confounders.

High Fiber Diet and Myeloma

The evolution of multiple myeloma from the precursor conditions, monoclonal gammopathy of unknown significance (MGUS) and smoldering myeloma, offer opportunities for secondary prevention, said Urvi A. Shah, MD, of Memorial Sloan Kettering Cancer Center (MSKCC) in New York City. Genomic alterations and progressive immune dysfunction occur during the transition to multiple myeloma, but many patients have modifiable risk factors that can affect the immune system, including diet/nutrition, obesity, diabetes, and microbiome diversity.

“Our hypothesis, or question, was ‘Can we tilt the scale and reduce risk for myeloma development if we normalize weight and blood sugar, improve diet quality, and improve the microbiome,'” she said.

Shah and colleagues designed the NUTRIVENTION study to determine whether a plant-based diet can affect the trajectory of MGUS and smoldering myeloma. They enrolled 20 patients who met diagnostic criteria for either of the two myeloma precursors and had a BMI >25.

Gape contributors consumed plant-basically based utterly, excessive-fiber meals for 12 weeks, most of which were shipped to the contributors. Patients may maybe maybe maybe indulge in to satiety and not using a calorie restrictions. The predominant endpoint of the pilot peer was as soon as feasibility, defined as >70% adherence to the meals and BMI reduction >5% at 12 weeks. Apply-up endured for a total of 52 weeks.

Within the course of the predominant 12 weeks, adherence to the weight reduction map was as soon as 91%, and a majority of patients (58%) remained adherent at 52 weeks, as in contrast with 20% adherence earlier than the peer. People had a median BMI reduction of seven% at 12 weeks, and the advance was as soon as maintained up to 52 weeks. To boot to meeting the adherence and BMI objectives, the patients had favorable adjustments in a selection of biochemical markers, alongside with insulation resistance, fecal microbiome vary, and irritation, as successfully as improved quality of existence.

“We moreover seen that two patients with progressive illness had the development stabilize and slack down on the intervention,” acknowledged Shah. “Even supposing or now not it’s merely two conditions, to our knowledge, it has now not been shown earlier than in an intervention surroundings that probabilities are you’ll maybe maybe be ready to make stronger weight reduction map and lifestyle and in fact slack or commerce the trajectory of the illness.”

Investigators at San Raffaele Health facility in Milan, Italy, performed a accomplice peer in a mouse mannequin of smoldering myeloma. Within the animals that consumed a excessive-fiber weight reduction map, development to an entire lot of myeloma slowed from a median of 12 weeks to 30 weeks. All of the animals in a retain watch over team stepped forward to an entire lot of myeloma, whereas 40% of the animals that consumed a excessive-fiber weight reduction map did not progress to over myeloma.

Biochemical learn of the mice confirmed that consumption of the excessive-fiber weight reduction map was as soon as related to increased microbiome vary, reduced boost rate of irregular plasma cells (suggesting an set on illness development), reduced irritation, and improved immune characteristic.

Shah acknowledged enrollment has begun in a apply-up trial (NUTRIVENTION-3) that will encompass 150 patients with MGUS or smoldering myeloma, randomized to the excessive-fiber weight reduction map with or without dietary supplements or to a placebo team.