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Neutropenic diets to prevent cancer infections: updated systematic review and meta-analysis
  1. Mohamad Bassam Sonbol1,
  2. Tania Jain2,
  3. Belal Firwana3,
  4. Talal Hilal1,
  5. Thomas Deleon1,
  6. Angela Murad4,
  7. M Hassan Murad5 and
  8. Nandita Khera1
  1. 1 Division of Hematology/Oncology, Mayo Clinic, Phoenix, Arizona, USA
  2. 2 Adult Bone Marrow Transplant Service, New York City, Manhattan, USA
  3. 3 Heartland Cancer Research NCORP, Missouri Baptist Medical Center, St Louis, Missouri, USA
  4. 4 Healthy Living Program, Mayo Clinic, Rochester, Minnesota, USA
  5. 5 Mayo Clinic, Rochester, MN, USA
  1. Correspondence to Dr Mohamad Bassam Sonbol, Mayo Clinic Cancer Center, Phoenix, Arizona, USA; sonbol.mohamad{at}


Introduction Multiple studies have questioned the benefit of neutropenic diets in decreasing infections in patients with cancer, but recent surveys showed that such diets are still prescribed. In this study, we sought to evaluate the effectiveness of neutropenic diet in decreasing infection and mortality in neutropenic patients with cancer with neutropenia. This review is an update of a previously published systematic review.

Materials and methods We searched different databases to identify comparative studies that investigated the effect of neutropenic diet compared with regular diet in neutropenic adults and children with cancer. We conducted random‐effects meta‐analyses using the Der‐Simonian and Laird method to pool treatment effects from included studies. Outcomes of interest were mortality, bacteremia/fungemia, major infections, quality of life, and the composite outcome for neutropenic fever and/or infection.

Results We included six studies (five randomised) with 1116 patients, with 772 (69.1%) having underwent haematopoietic cell transplant. There was no statistically significant difference between neutropenic diet and regular diet in the rates of major infections (relative risk [RR] 1.16; 95% CI 0.94 to 1.42) or bacteremia/fungemia (RR 0.96; 95% CI 0.60 to 1.53). In haematopoietic cell transplant patients, neutropenic diet was associated with a slightly higher risk of infections (RR 1.25; 95% CI 1.02 to 1.54). No difference in mortality was seen between neutropenic diet and regular diet (RR 1.08, 95% CI 0.78 to 1.50).

Conclusion There is currently no evidence to support the use of neutropenic diet or other food restrictions in neutropenic patients with cancer. Patients and clinicians should continue to follow the safe food-handling guidelines as recommended by the U.S. Food and Drug Administration.

  • neutropenic diet
  • low-bacterial diet
  • neutropenia
  • cancer
  • hematopoietic stem cell transplant

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  • Contributors All authors were involved in the conception and design of this study. MBS wrote the paper. All authors were involved in revising the article critically. All authors approved the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.