Nonrestrictive diet does not increase infections during post-HSCT neutropenia: data from a multicenter randomized...

Area of Science:

• Hematology
• Infectious Diseases
• Nutrition Science

Background:

• Infections are a significant cause of morbidity and mortality in neutropenic patients post-hematopoietic stem cell transplantation (HSCT).
• A low-microbial protective diet (PD) is standard care, but its prospective efficacy is unproven.

Purpose of the Study:

• To compare the efficacy and safety of a nonrestrictive diet (NRD) versus a protective diet (PD) in patients undergoing HSCT or high-dose chemotherapy.
• To assess the impact of diet on infection rates, mortality, and patient-reported outcomes.

Main Methods:

• A multicenter, randomized, noninferiority trial.
• 222 adult patients undergoing high-dose induction chemotherapy or HSCT were randomized to NRD or PD.
• Outcomes included incidence of infections, mortality during neutropenia, hospitalization length, and patient satisfaction.

Main Results:

• No significant difference in grade ≥2 infections or death during neutropenia between NRD and PD groups.
• Multivariable analysis identified multiple myeloma, fluoroquinolone prophylaxis, and absence of mucositis as factors reducing infection risk.
• NRD was associated with higher patient-reported satisfaction, with no significant variations in hospitalization, mucositis, GI infections, or nutritional markers.

Conclusions:

• A nonrestrictive diet is not inferior to a protective diet for neutropenic patients post-HSCT.
• Restrictive diets may unnecessarily burden patients' quality of life without improving clinical outcomes.