Myeloma patients can become "neutropenic" during some myeloma treatment, especially during the first 30-days of stem cell transplant. Being neutropenic means that you have a low white blood cell count, making it difficult to fight infection. If you become neutropenic it is important to take special precautions with your diet. A neutropenic diet is a way of protecting yourself from foodborne illness.

Here are some general guidelines you'll want to be aware of:

Foods to Avoid

• Raw and undercooked meat as well as deli, processed and cured meats (unless heated until steaming hot)
• Uncooked raw tempeh, miso and tofu
• Meat spreads or pâté
• Smoked seafood
• Raw fish and shellfish (clams, mussels and oysters) or sushi
• Raw and undercooked eggs (including homemade Caesar dressing, fresh mayo and raw cookie dough
• Raw sprouts: alfalfa, clover, radish and bean sprouts
• Salad bars, buffets and potlucks
• Unpasteurized dairy products such as milk, cheese (most soft cheeses but safe if melted), eggnog
• Mold-ripened cheese like Roquefort, Stilton, Gorgonzola and blue cheese
• Soft serve ice cream and frozen yogurt
• Ice cream scooped at restaurants
• Fermented dairy like kefir
• Cheese sliced at the deli counter
• Cheese that has uncooked vegetables
• Unpasteurized honey, juice and cider
• Fresh and packaged foods that are past their expired date
• Leftovers older than 48 hours
• Undercooked or raw brewer's yeast
• Salads from delis or salad bars
• Berries such as strawberries, raspberries and blackberries
• Precut fruits and vegetables
• Unwashed raw or frozen fruits, vegetables and herbs
• All nuts that are sold open and in bulk, as in some health-food or specialty stores
• Unpasteurized raw nuts
• Roasted nuts in the shell, such as pistachios or peanuts in the shell
• Freshly ground peanut butter or nut butters (not commercially packaged)
• Any bulk foods found in restaurants or stores

Food Preparation

• Make sure to keep your fresh food safe by refrigerating or freezing it immediately after purchase.
• Cook food immediately after defrosting and do not defrost food on the counter.
• Properly wash your hands before preparing food
• Avoid wooden cutting boards and use separate cutting boards for meat and produce
• Don't reuse dishes that have held raw meat or fish without cleaning with soap and water

There is much you CAN eat while you are neutropenic, so please know that you can choose from a wide variety of healthy options.

For example, you can make healthy soups and stews with fresh but cooked vegetables. You can cook berries or fruits with thin skins into cobblers or compote. You can toast soft cheeses like Brie over bread, make hardboiled eggs or cook spinach instead of having a salad. You can still eat ice cream out of containers or cook your meat and vegetables in a stir-fry.

Remember, neutropenia doesn't last forever. You can protect yourself to be safe during neutropenia, but you can still enjoy your food!