Trifilio, S., Helenowski, I., Giel, M., Gobel, B., Pi, J., Greenberg, D., & Mehta, J. (2012). Questioning the role of a neutropenic diet following hematopoetic stem cell transplantation. Biology of Blood and Marrow Transplantation: Journal of the American Society for Blood and Marrow Transplantation, 18, 1385–1390.

To evaluate the effects of a general hospital diet (GD) and a neutropenic diet (ND) on the incidence of microbiologically confirmed infections in hematopoietic stem cell transplantation (HSCT) recipients.

In 2006, the organization replaced its ND with a GD that retained restrictions for undercooked meat, fish, and some unpasteurized dairy products but allowed fresh fruits and vegetables. Data were obtained from electronic medical records of consecutive hospitalized HSCT recipients who received the GD or the ND during neutropenia.  All patients were receiving standard antibiotic, antifungal, and antiviral prophylaxis.  The ND excluded all fresh fruits and vegetables, black pepper, raw and undercooked meats and cheeses, cold smoked fish, raw or unpasteurized dairy products, raw miso and grain products, and brewer’s yeast. The GD permitted black pepper and well-washed fresh fruits and vegetables but excluded raw tomatoes, seeds, and grains. Other diet restrictions remained in place.  All patients were placed on these particular diets around the time of neutropenia and reverted back to a GD once neutropenia resolved.

• In total, 726 patients (58.6% male, 41.4% female) were included. 
• Mean age was 57 (range 18–78).
• All patients were HSCT recipients. 
• The majority of patients had myeloma, non-Hodgkin lymphoma, or acute myeloid leukemia.
• Sixty to seventy percent of patients developed neutropenic fever.

• Single site
• Inpatient 
• Chicago

Patients were undergoing the active antitumor treatment phase of care.

This was a retrospective descriptive study.

• Neutropenic fever (defined as a temperature of >101°F or two temperatures >100.5°F with an absolute neutrophil count of <500/mm³)
• All positive microbial cultures from onset of neutropenia until hospital discharge
   

There were significantly fewer confirmed infections in the GD group (p < 0.0272). Diarrhea (p < 0.095) and urinary tract infection (p < 0.003) were more common in the ND group. Overall mortality and hospital length of stay was similar between the groups.  The ND group had a higher rate of infection after resolution of neutropenia, with more frequent Clostridium difficile and vancomycin-resistant enterococci infections (p < 0.07).

Maintaining an ND that restriced fresh fruits and vegetables did not reduce infection and was associated with an increased risk of infection after resolution of neutropenia.

• Risk of bias (no control group, no blinding, no random assignment) 
• Retrospective descriptive study design

The study findings provide further evidence that restricting fresh fruits and vegetables from the diet of patients who are neutropenic is not beneficial.  These findings suggest that such restrictions may have a negative impact.