Neutrodiet: non-restricted diet is the preferred option after SCT

In patients with neutropenia after stem cell transplantation (SCT), a non-restrictive diet resulted in comparable infection and death rates as a so-called ‘protective’ diet, demonstrating that a restrictive diet is an unnecessary burden for these patients, altering their quality-of-life.

“Infections are a major cause of morbidity and mortality during neutropenia, following SCT,” said Prof. Federico Stella (Università degli Studi di Milano, Italy). Restrictive diets are widely used in centres performing SCT to prevent infections [1]. However, according to Prof. Stella, evidence for the efficacy of these practices is lacking. The non-inferiority, phase 3 Neutrodiet trial aimed to address this issue [2]. Patients who underwent an autologous or allogeneic SCT (n=230) were randomised 1:1 to a protective diet or an unrestricted diet. In the protective diet arm, the patients’ food was cooked >80°C unless it was thick peel fruit. Furthermore, yogurt, honey, cold cuts and sausages, raw fish, raw meat, raw vegetables, and raw fruits were forbidden to consume. Patients in the unrestricted diet arm did not receive raw fish or raw meat either. The primary study endpoint was the rate of grade ≥2 infections during the period of neutropenia.

No difference was observed in the rate of grade ≥2 infections between the protective diet arm and the non-restricted diet arm (65% vs 62%; RR 1.0; 95% CI 0.8–1.3; P=0.8). In addition, severe infections, gastrointestinal infections, sepsis, pneumonia, and fever of undetermined origin occurred equally often in the study arms. One death was reported in the protective diet arm and no deaths were observed in the non-restricted diet arm. Furthermore, the incidence of grade ≥3 graft-versus-host disease did not significantly differ between the two arms, with a rate of 20% in the protective diet arm and a rate of 9.5% in the non-restricted diet arm (P=0.4). Dr Stella mentioned that the mean body weight loss at 1 month was lower in the non-restricted diet arm than in the protective diet arm (2.7 kg vs 3.7 kg; P=0.04). Finally, the non-restricted diet was associated with higher satisfaction rates than the protective diet.

These results support the use of a non-restricted diet in patients with neutropenia after SCT, since a protective diet does not appear to influence infection rates but alters the patients’ quality-of-life.

1. Peric Z, et al. Bone Marrow Transplant. 2018;53(8):1030–1037.
2. Stella F, et al. Non-Restrictive Diet Does Not Increase Infections in Patients with Neutropenia after Stem Cell Transplantation: Final Analysis of the Neutrodiet Multicenter, Randomized Trial. Abstract 169, ASH 64^th Annual Meeting, 10–13 December 2022, New Orleans, LA, USA.

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Posted on 20 February 2023