So, neutropenia is when there is a type of white blood cells called neutrophils that are very low or absent in the blood. Neutrophils are very important in fighting bacteria and fungi and the melphalan kills the neutrophils or the cells that produce the neutrophils in the bone marrow. And until the new stem cells kick in, new neutrophils won't be made. So typically, four to five days after the transplant, the neutrophil count will start going very low, usually under 500. That's when we worry about infections. And typically it stays there for about five to seven days before it starts recovering. So that period of time, people are more susceptible to bacterial infections in particular. The neutropenic diet is where you minimize the types of foods that maybe aren't cooked well that have bacteria on them. So for example, moldy cheese, right? Blue cheese. That's not a good idea during a neutropenia because it can increase the risk for infection. So things that are not washed well, so things that aren't cooked well, like raw eggs, those things should be avoided during neutropenia. But there are a lot of controversies in this area. So eventually the low white blood cell count will recover on its own when the new stem cells are basically going to be making new white blood cells. That process takes anywhere from seven to 14 days. We can accelerate that process by giving a growth factor, the same growth factor we use to mobilize stem cells from the blood called GCSF. We use it after the transplant. At our center, we start it around day seven when the stem cells have had a chance to expand a little bit and then we kick them into gear. And usually within three to four days of giving those injections, white blood cell count recovery is hastened by those injections, by two to three days on average. The neutropenic diet is where you minimize the types of foods that maybe aren't cooked well that have bacteria on them. So for example, moldy cheese, blue cheese, that's not a good idea during a neutropenia because it can increase the risk for infection. So things that are not washed well, so things that aren't cooked well, like raw eggs, those things should be avoided during neutropenia. But there are a lot of controversies in this area. We do understand now that within our gut there is a large microbiome. And some studies suggest that following strict neutropenic diets make absolutely no difference in how patients get through transplant. So normally what I tell patients is eat a healthy diet, avoid certain foods that increase your risk. As long as food is cooked, it's generally good. Most of the time during the transplant procedure, I tell them to eat chicken noodle soup because you know, it's like getting through a flu that works real well. And it's light on the stomach. So that's usually what I recommend. So we're actually looking to change our practice when it comes to the neutropenic diet. There was a very nice trial that was just presented at this year's ASH meeting where they actually randomized patients to the neutropenic diet versus a routine normal diet that was sensible. And they found no differences in terms of the infectious rates and patient satisfaction was much higher. We ask patients to be sensible. So we ask them to cook food properly, to not consume raw or undercooked products. The same as, you know, sensible practice for any patient who's immunosuppressed. We ask them to, you know, wash things carefully, peel things that need to be peeled. But you know, other than that, I think it's important for patients to eat what feels good for them as long as it's sensible, has high nutritional value, isn't too high in empty calories. Those are the kind of things that we ask patients to steer towards and then to steer away from things that could potentially bear foodborne pathogens and be risk to them in terms of food poisoning.
HealthTree • September 19, 2024
