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

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.