[EmFuller]

How to treat post-transplant C. diff?

by EmFuller on Wed Apr 17, 2019 4:07 pm

Hi all,

My name is Emily, and I am from Brisbane, Australia. My father in law is currently being treated for multiple myeloma and is now on maintenance following a stem cell transplant last October. Since his stay in hospital, he has tested positive for C. diff (Clostridium difficile) and is now on his fourth course of vancomycin to treat the C. diff. The last course he had lasted 6 weeks.

However, the vancomycin doesn’t seem to get rid of the bacteria. It only suppresses it while he is being treated, and writhin 7-10 days the diarrhoea is back in full force. It’s been 6 months, and the C. diff is affecting his quality of life greatly, but doesn’t seem to be of great concern for his medical team.

From what I’ve read, unless you have good gut flora, you won’t be able to overcome the C.diff. The vancomycin suppressed the bacteria, but also kills of the healthy flora, meaning when the vancomycin is ceased, the spores are left to germinate again.

Does anyone know what the best approaches are for treating C. diff. in post-stem cell transplant multiple myeloma patients?

I’ve wondered about introducing probiotics to his diet, as he is so unwell he doesn’t feel like eating most of the time and isn’t getting the nourishment he needs. His doctor said we could try, but I’ve come across information suggesting it’s not a good idea if you’ve had a stem cell transplant.

Thanks,
Emily

[Ian]

Re: How to treat post-transplant C. diff?

by Ian on Thu Apr 18, 2019 2:26 am

G'day Emily,

I'm sorry to hear about your father-in-law's C. diff.

You can find some guidelines related to the treatment of C. diff, as well as other related issues, at this link:

https://www.idsociety.org/practice-guideline/clostridium-difficile/

Be sure to page down to the section with the heading "Treatment."

If I'm reading the guidelines correctly, they indicate that fidaxomicin should be attempted in cases where C. diff has returned after initial treatment with vancomycin. (Fidaxomicin is approved in Oz, by the way..

The other approach to be considered is a so-called "fecal transplant". It's discussed as an option in the guidelines I link to above, and it's also mentioned as an option for refractory C. diff in this forum thread: "Mom in ICU, fighting for her life" (started April 11, 2013).

Finally, you mention that your father in law is on maintenance therapy. Is it Revlimid? If it is, the Revlimid may be making the situation in your father's GI tract worse because the drug often causes chronic diarrhoea. Perhaps it is worth discussing other maintenance options, or perhaps having your father go off of maintenance until the C. diff is resolved.

I hope a solution is found for your father-in-law's problem. Please update us on how things go.

Cheers!