---
title: "Fecal Filtrate Transplantation for Fulminant Clostridioides difficile in Aplastic Hematology Patie"
id: "pubmed-42635401"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42635401"
content_type: "clinical_feed_article"
specialty: "Pharmacology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42635401/"
doi: "10.1080/19490976.2026.2718620"
published_at: "2026-08-24T16:06:44.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Fecal Filtrate Transplantation for Fulminant Clostridioides difficile in Aplastic Hematology Patie
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42635401
- **Specialty:** [Pharmacology](https://medichelpline.com/clinical-feed/pharmacology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42635401/)
- **DOI:** [10.1080/19490976.2026.2718620](https://doi.org/10.1080%2F19490976.2026.2718620)
- **Published At:** 2026-08-24T16:06:44.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Study type: single-center, prospective, protocol-defined pilot case series evaluating **fecal filtrate transplantation (FFT)** as salvage therapy for fulminant **Clostridioides difficile** infection (CDI) in adults with hematologic malignancies during chemotherapy-induced grade-4 aplasia. - Eligibility: consecutive adults with hematologic malignancy, chemotherapy-induced grade-4 aplasia, and fulminant CDI refractory to ≥5 days of high-dose oral vancomycin plus IV metronidazole and tigecycline. - Intervention: FFT prepared from a single unrelated donor by sequential centrifugation and filtration; administered via nasogastric tube in two doses. - Primary outcome: sustained clinical cure. Secondary outcomes: survival and adverse events assessed at +14 and +30 days post-FFT. - Microbiologic and mechanistic assays: 16S rRNA gene sequencing for bacterial community analysis; viral metagenomics and in vitro propagation assays to characterize donor–recipient phageome interactions. - Patients: three adults with adverse-risk acute myeloid leukemia and fulminant CDI caused by genetically distinct C. difficile strains received FFT. - Clinical outcomes: all three patients achieved clinical resolution by day +14 with improvements in abdominal distension and inflammatory markers. By day +30, two patients remained in remission; one died from Pseudomonas aeruginosa septic shock (not attributed to FFT). - Safety: FFT was well tolerated with no immediate procedure-related complications or FFT-attributable adverse events reported. - Microbiome/phage findings: heterogeneous bacterial community shifts after FFT; no consistent evidence that donor-derived phages explained CDI resolution. Observed induction of prophages in recipient-associated Clostridium species, suggesting stress-induced prophage activation might have contributed to decolonization. - Feasibility and implication: FFT was feasible in this high-risk aplastic population and produced rapid sustained CDI resolution in this small pilot cohort. Findings are preliminary and mechanistic signals were heterogeneous. - Trial registration: ClinicalTrials.gov NCT07172191. Details on long-term outcomes, reproducibility, and generalizability were not reported beyond the pilot series.
## Clinical Analysis & Structured Key Points
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Epub 2026 Aug 24. # Fecal filtrate transplantation as salvage therapy for fulminant _Clostridioides difficile_ infection in adult hematological patients during chemotherapy-induced aplasia: a pilot experience [Dorina Korózs](https://pubmed.ncbi.nlm.nih.gov/?term=Kor%C3%B3zs+D&cauthor_id=42635401)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42635401/#full-view-affiliation-1 "Semmelweis University, Doctoral School of Clinical Medicine, Budapest, Hungary.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42635401/#full-view-affiliation-2 "South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Budapest, Hungary."), [Bálint Gergely Szabó](https://pubmed.ncbi.nlm.nih.gov/?term=Szab%C3%B3+BG&cauthor_id=42635401)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42635401/#full-view-affiliation-1 "Semmelweis University, Doctoral School of Clinical Medicine, Budapest, Hungary.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42635401/#full-view-affiliation-2 "South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Budapest, Hungary.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42635401/#full-view-affiliation-3 "Department of Haematology and Internal Medicine, Division of Infectology, Semmelweis University, Budapest, Hungary."), [Gábor Apjok](https://pubmed.ncbi.nlm.nih.gov/?term=Apjok+G&cauthor_id=42635401)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42635401/#full-view-affiliation-4 "HUN-REN Biological Research Centre, National Laboratory of Biotechnology, Institute of Biochemistry, Synthetic and Systems Biology Unit, Szeged, Hungary."), [Viktor Lakatos](https://pubmed.ncbi.nlm.nih.gov/?term=Lakatos+V&cauthor_id=42635401)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42635401/#full-view-affiliation-2 "South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Budapest, Hungary."), [Krisztina Jeszenszky](https://pubmed.ncbi.nlm.nih.gov/?term=Jeszenszky+K&cauthor_id=42635401)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42635401/#full-view-affiliation-1 "Semmelweis University, Doctoral School of Clinical Medicine, Budapest, Hungary.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42635401/#full-view-affiliation-2 "South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Budapest, Hungary."), [Katalin Kamotsay](https://pubmed.ncbi.nlm.nih.gov/?term=Kamotsay+K&cauthor_id=42635401)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42635401/#full-view-affiliation-2 "South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Budapest, Hungary."), [Gabriella Hajbel-Vékony](https://pubmed.ncbi.nlm.nih.gov/?term=Hajbel-V%C3%A9kony+G&cauthor_id=42635401)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42635401/#full-view-affiliation-5 "National Center for Public Health and Pharmacy, Budapest, Hungary."), [Ákos Tóth](https://pubmed.ncbi.nlm.nih.gov/?term=T%C3%B3th+%C3%81&cauthor_id=42635401)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42635401/#full-view-affiliation-5 "National Center for Public Health and Pharmacy, Budapest, Hungary."), [János Sinkó](https://pubmed.ncbi.nlm.nih.gov/?term=Sink%C3%B3+J&cauthor_id=42635401)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42635401/#full-view-affiliation-2 "South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Budapest, Hungary.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42635401/#full-view-affiliation-3 "Department of Haematology and Internal Medicine, Division of Infectology, Semmelweis University, Budapest, Hungary."), [Péter Reményi](https://pubmed.ncbi.nlm.nih.gov/?term=Rem%C3%A9nyi+P&cauthor_id=42635401)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42635401/#full-view-affiliation-2 "South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Budapest, Hungary."), [Bálint Kintses](https://pubmed.ncbi.nlm.nih.gov/?term=Kintses+B&cauthor_id=42635401)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42635401/#full-view-affiliation-4 "HUN-REN Biological Research Centre, National Laboratory of Biotechnology, Institute of Biochemistry, Synthetic and Systems Biology Unit, Szeged, Hungary.")[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42635401/#full-view-affiliation-6 "HUN-REN TKI, Budapest, Hungary.") Affiliations Expand ### Affiliations * 1 Semmelweis University, Doctoral School of Clinical Medicine, Budapest, Hungary. * 2 South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Budapest, Hungary. * 3 Department of Haematology and Internal Medicine, Division of Infectology, Semmelweis University, Budapest, Hungary. * 4 HUN-REN Biological Research Centre, National Laboratory of Biotechnology, Institute of Biochemistry, Synthetic and Systems Biology Unit, Szeged, Hungary. * 5 National Center for Public Health and Pharmacy, Budapest, Hungary. * 6 HUN-REN TKI, Budapest, Hungary. * PMID: **42635401** * DOI: [ 10.1080/19490976.2026.2718620 ](https://doi.org/10.1080/19490976.2026.2718620) Item in Clipboard # Fecal filtrate transplantation as salvage therapy for fulminant _Clostridioides difficile_ infection in adult hematological patients during chemotherapy-induced aplasia: a pilot experience Dorina Korózs et al. Gut Microbes. 2026. Show details Display options Display options Format Abstract PubMed PMID Gut Microbes Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Gut+Microbes%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Gut+Microbes%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42635401/) . 2026 Dec 31;18(1):2718620. doi: 10.1080/19490976.2026.2718620. Epub 2026 Aug 24. ### Authors [Dorina Korózs](https://pubmed.ncbi.nlm.nih.gov/?term=Kor%C3%B3zs+D&cauthor_id=42635401)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42635401/#short-view-affiliation-1 "Semmelweis University, Doctoral School of Clinical Medicine, Budapest, Hungary.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42635401/#short-view-affiliation-2 "South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Budapest, Hungary."), [Bálint Gergely Szabó](https://pubmed.ncbi.nlm.nih.gov/?term=Szab%C3%B3+BG&cauthor_id=42635401)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42635401/#short-view-affiliation-1 "Semmelweis University, Doctoral School of Clinical Medicine, Budapest, Hungary.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42635401/#short-view-affiliation-2 "South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Budapest, Hungary.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42635401/#short-view-affiliation-3 "Department of Haematology and Internal Medicine, Division of Infectology, Semmelweis University, Budapest, Hungary."), [Gábor Apjok](https://pubmed.ncbi.nlm.nih.gov/?term=Apjok+G&cauthor_id=42635401)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42635401/#short-view-affiliation-4 "HUN-REN Biological Research Centre, National Laboratory of Biotechnology, Institute of Biochemistry, Synthetic and Systems Biology Unit, Szeged, Hungary."), [Viktor Lakatos](https://pubmed.ncbi.nlm.nih.gov/?term=Lakatos+V&cauthor_id=42635401)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42635401/#short-view-affiliation-2 "South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Budapest, Hungary."), [Krisztina Jeszenszky](https://pubmed.ncbi.nlm.nih.gov/?term=Jeszenszky+K&cauthor_id=42635401)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42635401/#short-view-affiliation-1 "Semmelweis University, Doctoral School of Clinical Medicine, Budapest, Hungary.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42635401/#short-view-affiliation-2 "South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Budapest, Hungary."), [Katalin Kamotsay](https://pubmed.ncbi.nlm.nih.gov/?term=Kamotsay+K&cauthor_id=42635401)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42635401/#short-view-affiliation-2 "South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Budapest, Hungary."), [Gabriella Hajbel-Vékony](https://pubmed.ncbi.nlm.nih.gov/?term=Hajbel-V%C3%A9kony+G&cauthor_id=42635401)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42635401/#short-view-affiliation-5 "National Center for Public Health and Pharmacy, Budapest, Hungary."), [Ákos Tóth](https://pubmed.ncbi.nlm.nih.gov/?term=T%C3%B3th+%C3%81&cauthor_id=42635401)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42635401/#short-view-affiliation-5 "National Center for Public Health and Pharmacy, Budapest, Hungary."), [János Sinkó](https://pubmed.ncbi.nlm.nih.gov/?term=Sink%C3%B3+J&cauthor_id=42635401)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42635401/#short-view-affiliation-2 "South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Budapest, Hungary.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42635401/#short-view-affiliation-3 "Department of Haematology and Internal Medicine, Division of Infectology, Semmelweis University, Budapest, Hungary."), [Péter Reményi](https://pubmed.ncbi.nlm.nih.gov/?term=Rem%C3%A9nyi+P&cauthor_id=42635401)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42635401/#short-view-affiliation-2 "South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Budapest, Hungary."), [Bálint Kintses](https://pubmed.ncbi.nlm.nih.gov/?term=Kintses+B&cauthor_id=42635401)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42635401/#short-view-affiliation-4 "HUN-REN Biological Research Centre, National Laboratory of Biotechnology, Institute of Biochemistry, Synthetic and Systems Biology Unit, Szeged, Hungary.")[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42635401/#short-view-affiliation-6 "HUN-REN TKI, Budapest, Hungary.") ### Affiliations * 1 Semmelweis University, Doctoral School of Clinical Medicine, Budapest, Hungary. * 2 South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Budapest, Hungary. * 3 Department of Haematology and Internal Medicine, Division of Infectology, Semmelweis University, Budapest, Hungary. * 4 HUN-REN Biological Research Centre, National Laboratory of Biotechnology, Institute of Biochemistry, Synthetic and Systems Biology Unit, Szeged, Hungary. * 5 National Center for Public Health and Pharmacy, Budapest, Hungary. * 6 HUN-REN TKI, Budapest, Hungary. * PMID: **42635401** * DOI: [ 10.1080/19490976.2026.2718620 ](https://doi.org/10.1080/19490976.2026.2718620) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Background:** Fulminant _Clostridioides difficile_ infection (CDI) in patients with hematologic malignancies during chemotherapy-induced aplasia carries high mortality and limited treatment options. Our objective was to evaluate fecal filtrate transplantation (FFT) as a salvage therapy for fulminant CDI during aplasia, and to explore whether donor-recipient phage dynamics may contribute to clinical response. **Methods:** We conducted a single-center, prospective, protocol-defined pilot case series study including consecutive adults with hematologic malignancies, chemotherapy-induced grade-4 aplasia and fulminant CDI, refractory to ≥5 d of high-dose oral vancomycin plus intravenous metronidazole and tigecycline. FFT was prepared from a single unrelated donor using sequential centrifugation and filtration, and administered via nasogastric tube in two doses. The primary outcome was sustained clinical cure, secondary outcomes included survival and adverse events, assessed at +14 and +30 d post-FFT. 16S rRNA gene sequencing was used to assess microbiome compositions, while viral metagenomics and _in vitro_ propagation assays were employed to characterize donor-recipient phageome interactions. **Results:** Three patients with adverse-risk acute myeloid leukemia and fulminant CDI caused by genetically distinct _C. difficile_ strains received FFT. All patients achieved clinical resolution by day +14, accompanied by improvements in abdominal distension and inflammatory markers. By day +30, one patient died from _Pseudomonas aeruginosa_ septic shock, while two maintained remission with confirmatory follow-up. FFT was well tolerated, with no procedure-related immediate complications or FFT-attributable adverse events. Microbiome and phage profiling revealed heterogeneous responses, including shifts in bacterial community composition, with no clear evidence for a general role of donor-derived phages in CDI resolution. In contrast, we observed induction of prophages harbored by recipient-associated _Clostridium_ species, which may have contributed to decolonization through stress-induced entry into the lytic cycle. **Conclusions:** FFT was feasible, with rapid sustained CDI resolution in hematologic patients with chemotherapy-induced aplasia. **Trial registration:** ClinicalTrials.gov identifier [NCT07172191](http://clinicaltrials.gov/show/NCT07172191 "See in ClinicalTrials.gov"). **Summary:** Prospective single-center pilot study of fecal filtrate transplantation (FFT) for fulminant-refractory _C. difficile_ infection in three aplastic adult hematologic patients. FFT was well tolerated, achieved rapid clinical cure, and showed heterogeneous microbiome and phageome modulation, potentially contributing to therapeutic effects. **Keywords:** FMT; Neutropenia; aplasia; fecal filtrate; fecal filtrate transplantation; fecal microbiota transplantation; phageome; stool supernatant; stool transplantation; virome. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Similar articles * [ Fecal microbiota transplantation for the treatment of recurrent Clostridioides difficile (Clostridium difficile). ](https://pubmed.ncbi.nlm.nih.gov/37096495/) Minkoff NZ, Aslam S, Medina M, Tanner-Smith EE, Zackular JP, Acra S, Nicholson MR, Imdad A.Minkoff NZ, et al.Cochrane Database Syst Rev. 2023 Apr 25;4(4):CD013871. doi: 10.1002/14651858.CD013871.pub2.Cochrane Database Syst Rev. 2023.PMID: 37096495Free PMC article. * [ Effect of Fecal Microbiota Transplantation on Recurrence in Multiply Recurrent Clostridi
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