Role of Neutropenic Diet in Prevention of Infection and Graft-versus-Host Disease in Haematopoietic Stem Cell Transplant Recipients: Systematic Review and Meta-Analysis Protocol

Why It Matters

If restrictive neutropenic diets do not confer measurable benefits, transplant centres can abandon costly, patient‑burdensome restrictions, improving nutrition, microbiome health, and overall outcomes.

Key Takeaways

• Neutropenic diet restricts raw produce, unpasteurised dairy, undercooked meats.
• Review will assess infection, acute GVHD, nutrition, and patient satisfaction.
• Includes RCTs and observational studies across all ages and graft sources.
• Will evaluate cost, microbiome impact, and quality‑of‑life outcomes.

Pulse Analysis

Haematopoietic stem cell transplantation remains a curative option for many hematologic malignancies, yet early post‑transplant infection and graft‑versus‑host disease (GVHD) drive significant morbidity and mortality. Historically, transplant centres have imposed neutropenic or low‑microbial diets—eliminating raw fruits, vegetables, unpasteurised dairy, and undercooked meats—to limit microbial exposure during periods of profound neutropenia. While the rationale is intuitive, the practice persists despite limited trial evidence and growing concerns about nutritional adequacy, patient quality of life, and delayed gut microbiome recovery.

Recent guidelines from European societies such as EBMT and ESPEN have shifted toward rigorous food‑safety protocols rather than blanket dietary bans, citing studies that show no clear infection‑prevention advantage and potential harms like malnutrition and reduced microbiota diversity. The new systematic review protocol, registered with PROSPERO, seeks to fill the evidence gap by aggregating data from randomized controlled trials and observational cohorts worldwide. By employing comprehensive search strategies, dual‑reviewer screening, and GRADE assessment, the review will generate pooled risk ratios for infection and acute GVHD, as well as mean differences for nutritional parameters and patient‑reported outcomes, offering a nuanced view of both benefits and drawbacks.

The implications for clinical practice are substantial. Should the meta‑analysis demonstrate negligible or adverse effects of neutropenic diets, transplant programmes could replace restrictive menus with evidence‑based food‑handling guidance, reducing costs associated with specialized meals and improving patient satisfaction. Conversely, if specific subgroups—such as those receiving myeloablative conditioning or certain graft sources—show measurable benefit, targeted dietary recommendations could be refined. Ultimately, the review will inform policy updates, guide dietitian involvement, and shape future research on microbiome‑focused nutrition strategies in HSCT care.