Role of the gut microbiome in the development and prognosis of pediatric leukemia

Abstract

The gut microbiome plays a pivotal role in immune homeostasis and systemic inflammatory regulation, both of which are critically involved in the pathogenesis and progression of pediatric leukemias. Recent evidence reveals that children with leukemia often exhibit distinct gut microbiome profiles at diagnosis, marked by reduced microbial diversity and the enrichment of pro-inflammatory taxa such as Enterococcus and Streptococcus. This microbial dysbiosis may promote leukemogenesis by disrupting immune regulation and driving chronic inflammation. Chemotherapy significantly alters the gut microbiome, inducing dysbiosis characterized by a loss of beneficial commensals and the dominance of pathobionts. Specific microbial signatures, such as the enrichment of Bacteroides, correlate with reduced inflammation and improved prognosis, underscoring the gut microbiome's prognostic value. Emerging therapies, including dietary adjustments, probiotics, and fecal gut microbiome transplantation, aim to restore microbial balance and reduce treatment-related complications. Moreover, gut microbiome profiling shows potential for identifying biomarkers linked to leukemia predisposition, paving the way for early diagnosis and tailored preventive strategies. This mini-review explores recent advancements in understanding the influence of the gut microbiome on pediatric leukemias, emphasizing its role as both a therapeutic target and a prognostic biomarker. Integrating gut microbiome research into clinical practice may help optimize treatment outcomes and improve quality of life for children with leukemia.

Keywords: Pediatric leukemia; Gut microbiome; Dysbiosis; Immune modulation; Microbiome-based therapy; Prognosis

Core Tip: The gut microbiome plays a pivotal role in the development, prognosis, and management of pediatric leukemias. This mini-review synthesizes current evidence on microbial dysbiosis as both a risk factor and prognostic biomarker, discusses methodological and safety challenges relating to gut microbiome research, and reviews innovative gut microbiome-targeted therapies. By advocating for pediatric-specific safety frameworks and integrating gut microbiome profiling into clinical protocols, this paper underscores the gut microbiome’s potential to transform early detection, personalized therapy, and long-term outcomes in pediatric leukemia.