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

Table 1 Microbiota-targeted interventions in pediatric leukemia

Intervention	Agent	Clinical implications	Ref.
Probiotics	Lactobacillus rhamnosus GG	Reduced gastrointestinal toxicity; reduced antibiotic use	Martyniak et al[20], 2023
Probiotics	Bifidobacterium breve Yakult	Fewer fever episodes; reduced pathogens	Todor and Ichim[8], 2025
Prebiotics	Inulin	Increased chemo efficacy; reduced complications	Martyniak et al[20], 2023
Prebiotics	Pectin	Protects gut barrier during chemo	Martyniak et al[20], 2023
Postbiotics	Butyrate	Anti-inflammatory; anti-leukemic	Martyniak et al[20], 2023
Synbiotics	LactoCare (multi-strain + prebiotic)	96% reduced diarrhea	Martyniak et al[20], 2023
FMT	Fresh/frozen FMT	86% response in steroid-refractory GvHD	Todor and Ichim[8], 2025
Nutrition	Enteral nutrition	Better hematopoietic stem cell transplantation outcomes; reduced GvHD	Muratore et al[19], 2022

FMT: Fecal microbiome transplantation; GvHD: Graft-versus-host disease.

Table 2 Emerging interventions in pediatric leukemia

Intervention	Agent	Clinical implications	Ref.
Lactoferrin	Bovine lactoferrin 200 mg/day	Prevents dysbiosis; reduced febrile neutropenia	Martyniak et al[20], 2023
Melatonin	Melatonin (various)	Increased microbiome diversity	Martyniak et al[20], 2023
Biomarkers	Quantitative polymerase chain reaction (Ruminococcaceae/Veillonella)	91% specificity for neutropenia risk	Sørum et al[9], 2025
VOC panel	Fecal VOC profiling	Predicts bloodstream infection 15 days pre-symptoms	van de Velde et al[4], 2022
Autologous fecal microbiome transplantation	Patient’s own stool	Personalized microbiome recovery	Todor and Ichim[8], 2025
Lactose-free diet	Conditioning/hematopoietic stem cell transplantation	Prevents Enterococcus blooms; reduced graft-versus-host disease	Muratore et al[19], 2022
High-fiber diet	≥ 5 g fiber/day	27% reduced leukemia risk (epidemiological)	Kameri et al[10], 2024

VOC: Volatile organic compound.

Table 3 Phase-specific interventions in pediatric leukemia

Phase	Key intervention	Agent	Clinical note	Ref.
Pre-diagnosis	Maternal probiotics	L. rhamnosus GG + Bifidobacterium infantis	38% reduced offspring ALL risk	Kameri et al[10], 2024
Pre-diagnosis	Breastfeeding	Exclusive > 6 months	27% reduced ALL risk	Kameri et al[10], 2024
Chemo	Probiotics	L. rhamnosus GG	Reduced gastrointestinal toxicity/infections	Martyniak et al[20], 2023
Chemo	Prebiotics	Inulin + butyrate	Increased tolerance	Martyniak et al[20], 2023
Chemo	Antibiotic stewardship	Reduced fluoroquinolone use	Preserves commensals	Dunn et al[11], 2022
HSCT	Enteral nutrition	Enteral nutrition vs parenteral nutrition	Maintains gut structure	Muratore et al[19], 2022
HSCT	Lactose avoidance	Lactose-free diet	Reduced Enterococcus dominance	Muratore et al[19], 2022
Recovery	Microbiome restoration	Fecal microbiome transplantation/targeted probiotics	Reduced late effects 29%	Todor and Ichim[8], 2025

ALL: Acute lymphoblastic leukemia; L. rhamnosus: Lactobacillus rhamnosus; HSCT: Hematopoietic stem cell transplantation.