{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T18:19:01Z","timestamp":1787681941999,"version":"build-2784847793"},"reference-count":83,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T00:00:00Z","timestamp":1787616000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Microbiol."],"abstract":"<jats:p>Leukemia care is a clinical experiment in ecosystem stress. Malignant hematopoiesis, intensive chemotherapy, hematopoietic cell transplantation, neutropenia, mucosal injury, broad-spectrum antibiotics and nutritional interruption converge to deplete anaerobic fermentative capacity and favor pathobiont domination. The central gap is not whether dysbiosis occurs, but how loss of fiber-dependent microbial function becomes barrier failure, infection risk, immune dysregulation, treatment toxicity and altered drug exposure. We reviewed adult or non-pediatric full-text literature published from 13 May 2021 to 13 May 2026, after excluding pediatric-focused studies, and integrated foundational evidence on dietary fiber, microbial metabolites and cancer microbiome methodology. The literature supports a therapeutic ecology model in which fermentable substrate, anaerobic redundancy, short-chain fatty acids, indoles, bile-acid derivatives and amino-acid metabolites form a linked fiber-microbiota-barrier axis. When this axis is disrupted by antibiotics, mucositis, sterile or low-residue diets, parenteral nutrition and hospitalization, the ecosystem can enter alternative stable states marked by domination, resistome expansion and reduced metabolite output. Evidence is strongest in acute myeloid leukemia, acute leukemia chemotherapy and hematopoietic cell transplantation, but emerging studies in chronic lymphocytic leukemia, chronic myeloid leukemia, CAR T-cell therapy and pharmacomicrobiomics extend the framework beyond infection prevention. We therefore argue that microbiota-directed nutrition in leukemia should be designed as a timed, safety-bounded ecological intervention rather than as a generic supplement. Future trials should combine dietary quantification, antibiotic metrics, strain-level microbiome profiling, metabolomics, barrier biomarkers, drug-exposure readouts and patient-centered outcomes to test whether restoring the fiber-microbiota-barrier axis improves adult leukemia care.<\/jats:p>","DOI":"10.3389\/fmicb.2026.1913406","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T17:26:46Z","timestamp":1787678806000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Therapeutic ecology of the fiber-microbiota-barrier axis in leukemia: resilience, immune recovery and pharmacomicrobiomics"],"prefix":"10.3389","volume":"17","author":[{"given":"Ruiyu","family":"Xie","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, The Fourth Hospital of Hebei Medical University","place":["Shijiazhuang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaotong","family":"Jing","sequence":"additional","affiliation":[{"name":"Department of Hematology, The Second Hospital of Hebei Medical University, Hebei Key Laboratory of Hematology","place":["Shijiazhuang, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,25]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1786","DOI":"10.1021\/jacsau.3c00682","article-title":"Cancer-stem-cell phenotype-guided discovery of a microbiota-inspired synthetic compound targeting NPM1 for leukemia","volume":"4","author":"Algar","year":"2024","journal-title":"JACS Au"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"417","DOI":"10.3390\/antibiotics15040417","article-title":"Gut microbiota and acute myeloid leukemia: state of the art, clinical signals, and translational opportunities","volume":"15","author":"Alvaro","year":"2026","journal-title":"Antibiotics"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1559033","DOI":"10.3389\/fmicb.2025.1559033","article-title":"Significant changes in gut microbiota and SCFAs among patients with newly diagnosed acute myeloid leukemia","volume":"16","author":"An","year":"2025","journal-title":"Front. 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