{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T22:09:28Z","timestamp":1793657368636,"version":"4.5.1"},"reference-count":47,"publisher":"American Society of Hematology","issue":"18","content-domain":{"domain":["ashpublications.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,10,29]]},"abstract":"<jats:sec>\n                    <jats:title>Abstract<\/jats:title>\n                    <jats:p>Dysbiosis after allogeneic hematopoietic stem cell transplant (allo-HSCT) predisposes to acute gastrointestinal (GI) graft-versus-host disease (GVHD). Human milk oligosaccharides (HMOs) are prebiotics that establish a favorable intestinal microbiome. We hypothesized that peritransplant HMOs would reduce dysbiosis, and conducted a prospective phase 1\/2 study in which 70 patients received oral, daily 2\u2019-fucosyllactose (2\u2019-FL), the most abundant HMO, from start of conditioning through day +30. Primary phase 1 and phase 2 end points were safety and tolerability of 2\u2032-FL and longitudinal preservation of microbiome diversity, respectively. Phase 1 and phase 2 patients with \u226560% adherence were evaluated by correlative analyses. Twenty-nine age-matched patients with available samples in our institutional biorepository served as contemporary controls. 2\u2032-FL was safe and well tolerated on the phase 1 study, which established dosing for the phase 2 study. Shannon diversity was preserved in 2\u2032-FL recipients and declined from baseline to day +30 in controls (P = .04). Generalized linear mixed model analysis revealed higher association of Bifidobacteria and Blautia with 2\u2032-FL (adjusted P&amp;lt; .05). Higher fecal isoleucine (P = .005), tyrosine (P = .05), and taurine (P = .04) were observed in 2\u2032-FL recipients, all associated with protection and regeneration of intestinal epithelium. Lower plasma regulatory islet-derived 3\u03b1 (P = .053) and suppressor of tumorigenicity 2 levels (P = .038) were observed in 2\u2032-FL recipients compared with controls. Incidence of grade II-IV acute GI GVHD was 0% in 2\u2032-FL recipients compared with 17% in controls (P = .009). Adenovirus reactivation was 0% in 2\u2032-FL recipients compared with 17% in controls (P = .009). 2\u2032-FL is safe and modifies the gut microbiome in children after allo-HSCT. This trial was registered at www.clinicaltrials.gov as #NCT04263597.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1182\/blood.2026034172","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T12:08:49Z","timestamp":1787227729000},"page":"2294-2305","update-policy":"https:\/\/doi.org\/10.1182\/blood.2019cm0000","source":"Crossref","is-referenced-by-count":2,"title":["Human milk oligosaccharide (2\u2032-FL) modifies the gut microbiome in children after bone marrow transplant"],"prefix":"10.1182","volume":"148","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-7176-2275","authenticated-orcid":false,"given":"Kristie N.","family":"Ramos","sequence":"first","affiliation":[{"name":"1Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, OH"},{"name":"2Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucille","family":"Langenberg","sequence":"additional","affiliation":[{"name":"1Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, OH"},{"name":"2Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1385-9928","authenticated-orcid":false,"given":"Kelly E.","family":"Lake","sequence":"additional","affiliation":[{"name":"1Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, OH"},{"name":"2Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colin","family":"Hoerth","sequence":"additional","affiliation":[{"name":"1Division of Bone Marrow 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Hospital Medical Center, Cincinnati, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6042-7303","authenticated-orcid":false,"given":"David","family":"Newburg","sequence":"additional","affiliation":[{"name":"4Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ardythe L.","family":"Morrow","sequence":"additional","affiliation":[{"name":"4Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas J.","family":"Ollberding","sequence":"additional","affiliation":[{"name":"1Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, OH"},{"name":"5Division of Biostatistics and Epidemiology, Cincinnati Children\u2019s 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