Neutropenic diet in acute leukemia patients did not lower mortality: BMJ

Tamil Nadu, India: In patients with acute leukemia, a neutropenic diet did not prevent infections, lower mortality, or alter the microbial ecology of the stool, says an article published in BMJ Supportive & Palliative Care.

Despite evidence to the contrary from high-income nations, patients with acute leukemia getting treatment in low- and middle-income countries (LMICs) are recommended to restrict their intake of raw fruits and vegetables (neutropenic diet) in order to decrease infections. Therefore, in order to determine the effectiveness of the neutropenic diet in an LMIC scenario, Venkatraman Radhakrishnan and colleagues carried out a randomized controlled experiment.

A neutropenic or normal diet was randomly assigned to patients undergoing induction chemotherapy for acute leukemia who were 1 to 60 years old. The main goal of the study was to assess how frequently patients consuming the two diets throughout induction chemotherapy experienced serious illnesses. Comparing the induction mortality rates and stool microbial flora was one of the secondary goals.

The key findings of this study were as follows:

1. 200 patients were randomly assigned to this trial, 98 to the standard diet group and 102 to the neutropenic diet group.

2. Major infections affected 32 (32% of patients) in the group receiving the usual diet and 26 (25%) in the group receiving the neutropenic diet.

3. For blood culture positive (n=6 vs. 9), inotropic support (17 vs. 12), mechanical ventilation (8 vs. 5), third-line antibiotic usage (28 vs. 20), minor infections (12 vs. 9), induction mortality (9 vs. 4) and remission status, patients receiving a standard diet vs a neutropenic diet did not show statistically significant differences (94% vs 94%).

4. On day 15 of induction, multidrug-resistant bacteria were detected in the stool of 38% of patients on the usual diet and 35% of patients on the neutropenic diet.

In conclusion, the notion that a neutropenic diet lowers infection and mortality in cancer patients will be dispelled by the findings of this study, giving such patients more nutritional options.

Reference:

Radhakrishnan, V., Lagudu, P. B. B., Gangopadhyay, D., Vijaykumar, V., Rajaraman, S., Perumal Kalaiyarasi, J., Ganesan, P., & Ganesan, T. S. (2022). Neutropenic versus regular diet for acute leukaemia induction chemotherapy: randomised controlled trial. BMJ Supportive & Palliative Care. https://doi.org/10.1136/spcare-2022-003833