Restrictive Diet May Not Be Necessary for Patients Undergoing HSCT

TON - February 2023 Vol 16, No 1

Patients undergoing hematopoietic stem-cell transplantation (HSCT) do not derive any benefit from the restrictive diet frequently prescribed to prevent infections, according to the results of a clinical trial presented during the 64th American Society of Hematology Annual Meeting and Exposition. The study investigators found that patients who followed a restrictive diet, which only allows foods that have been cooked to approximately 175° Fahrenheit and which forbids fresh fruits and vegetables, did not have significantly lower rates of infection compared with those who followed a standard hospital-prepared diet. Patients on the restrictive diet also reported a lower quality of life.

“This is good news for patients. It’s my absolutely favorite abstract from this year’s meeting. Patients no longer have to eat gruel. Around the world, we should eliminate these silly neutropenic diets, let people eat what they want, and give them a better quality of life while they are in the hospital,” said Mikkael Sekeres, MD, MS, Chief and Professor, Division of Hematology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, FL, who moderated a press conference where the research was presented.

“The findings show that the use of a restrictive diet is an unnecessary burden for our patients’ quality of life,” noted the study’s lead investigator, Federico Stella, MD, Hematology Resident, Università degli Studi di Milano–Istituto Nazionale dei Tumori, Italy.

For decades, patients undergoing surgery and transplantation have been instructed to eat a neutropenic, low-bacterial diet, but there is no reliable evidence to support this practice. Over the years, physicians and nutritionists have questioned the value of such a diet, which is designed to protect people with compromised immune systems from germs in food.

Study Details

Researchers assigned 247 patients who were awaiting HSCT or undergoing high-dose chemotherapy to either a low-bacterial diet or a nonrestrictive diet of standard hospital-prepared food, which included the option of fresh fruits and vegetables prepared according to safe handling procedures, as well as deli meats, pasteurized honey, and yogurt. The low-bacterial diet consisted of food cooked to at least 175° Fahrenheit and thick-skinned fruit. Raw fruits and vegetables, deli meats, honey, yogurt, and raw fish and meat were forbidden.

Patients followed the diet from the start of induction chemotherapy until their white blood cell counts recovered after HSCT.

At baseline, the 2 study groups were similar in terms of age (median age, 56 years), sex (approximately 57% were male), and reason for enrollment in the study (97% for HSCT and 3% for high-dose chemotherapy). HSCT patients were to be followed for 100 days and high-dose chemotherapy patients for 30 days.

Results showed that there was no statistically significant difference in the rate of ≥2 grade infections, which occurred in 38 (34%) patients assigned to the low-bacterial diet and 44 (39%) patients assigned to the nonrestrictive diet. In addition, no statistically significant differences were observed in rates of fever of unknown origin, sepsis, or gastrointestinal infection between the 2 groups.

There were also no significant differences regarding rates of graft-versus-host disease, feeding outcomes during length of hospitalization, nausea, need for intravenous nutrition, or adverse events up to 30 days following autologous stem-cell transplantation and 100 days following allogeneic stem-cell transplantation.

In addition, patients on the low-bacterial diet reported a lower quality of life compared with those on the nonrestrictive diet. Those assigned to the nonrestrictive diet reported higher satisfaction, with 35% indicating that their “prescribed diet did not negatively impact my alimentation” compared with only 16% of those assigned to the protective diet. Patients on the nonrestrictive diet experienced less weight loss 1 month after their procedure.

At the press conference, Dr Sekeres emphasized that in his experience, none of the HSCT patients he has ever treated has died from a foodborne infection. “When I was working in Cleveland some years ago, I eliminated the neutropenic diet on the leukemia floor. I faced a lot of resistance because people had been supporting this for decades. I love this study because it formally validates what I thought was true.”

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