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Protocol for systematic review and meta-analysis of dietary restrictions after haematopoietic stem cell transplantationDiet restrictions after stem cell transplant under review

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Key Takeaway
Note that this is a protocol for a systematic review and meta-analysis on dietary restrictions after HSCT.

This source is a protocol for a systematic review and meta-analysis focused on dietary interventions for patients undergoing haematopoietic stem cell transplantation. The population includes children or adults receiving grafts from any source and with any conditioning intensity. The intervention involves neutropenic, low-microbial, low-bacterial, or protective diets compared with unrestricted, less restrictive, standard hospital, or food-safety-based diets.

The review aims to evaluate primary outcomes such as infection rates, acute graft-versus-host disease, nutritional status, time to neutrophil recovery, and patient satisfaction or quality of life. Secondary outcomes include overall survival, relapse, chronic graft-versus-host disease, length of hospitalisation, antibiotic use to day 100, micronutrient deficiency, and cost outcomes.

Sample size and setting are not reported in this protocol. Adverse events, tolerability, and discontinuations are not reported. The authors note that findings will inform clinical practice, patient counselling, and future policy on dietary restrictions after HSCT. No specific numerical results or p-values are available because this is a protocol.

If you or a loved one has had a stem cell transplant, you know the diet rules can be overwhelming. No fresh fruits, no raw vegetables, no unpasteurized anything. The idea is to prevent infection. But do these strict diets actually work?

A new research review is set to find out. The review will look at studies comparing restrictive diets (like neutropenic or low-microbial diets) with more flexible, food-safety-based approaches. The goal is to see which approach leads to fewer infections, better nutrition, and higher quality of life.

This is important because these diets can be hard to follow and may lead to nutritional gaps. The review will also look at other outcomes like time to neutrophil recovery, graft-versus-host disease, and even cost. But it's important to note that this is just a protocol, meaning the review hasn't been done yet. The findings are not available.

So for now, patients and families should continue following their doctor's advice. But this review could eventually change how hospitals handle post-transplant nutrition.

What this means for you:
A planned review will clarify if strict post-transplant diets are worth the burden.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedMay 2026
View Original Abstract ↓
IntroductionHaematopoietic stem cell transplantation (HSCT) is associated with substantial early infectious risk, neutropenia, immunosuppression, and graft-versus-host disease (GVHD). Many centres continue to use neutropenic, low-microbial, low-bacterial, or protective diets to reduce dietary exposure to potential pathogens, despite variation in diet definitions and concerns regarding nutritional intake, patient experience, cost, and microbiota recovery. This protocol describes a systematic review and meta-analysis evaluating the benefits and harms of neutropenic diets compared with less restrictive, standard, or food-safety-based dietary approaches in HSCT recipients.MethodsWe will include randomised and non-randomised comparative studies involving children or adults undergoing HSCT from any graft source and conditioning intensity. Eligible interventions will include neutropenic, low-microbial, low-bacterial, or protective diets; comparators will include unrestricted, less restrictive, standard hospital, or food-safety-based diets. MEDLINE, Embase, CENTRAL, Web of Science, CINAHL, Scopus, ClinicalTrials.gov, and the WHO ICTRP will be searched from inception without language or date restrictions, supplemented by reference screening, expert contact, grey literature, and conference proceedings. Two reviewers will independently screen studies, extract data, and assess risk of bias using RoB 2 for randomised trials and RoBANS for non-randomised studies.ResultsThe primary outcomes will be infection rates, acute GVHD, nutritional status, time to neutrophil recovery, and patient satisfaction or quality of life. Secondary outcomes will include overall survival, relapse, chronic GVHD, length of hospitalisation, antibiotic use to day 100, micronutrient deficiency, and cost outcomes. Where appropriate, pooled estimates will be generated using random-effects models, with subgroup and sensitivity analyses used to explore heterogeneity. Certainty of evidence will be assessed using GRADE.DiscussionThis review will clarify whether neutropenic diets reduce infectious complications or GVHD after HSCT, and whether any potential benefit is offset by nutritional, patient-centred, microbiome-related, or economic harms. Findings will inform clinical practice, patient counselling, and future policy on dietary restrictions after HSCT.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420251162724, identifier PROSPERO (CRD420251162724).
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