Radhakrishnan Venkatraman, Lagudu Perraju Bhaskar Bhuvan, Gangopadhyay Devleena, Vijaykumar Varalakshmi, Rajaraman Swaminathan, Perumal Kalaiyarasi Jayachandran, Ganesan Prasanth, Ganesan Trivadi S
Cancer Institute-WIA, Chennai, Tamil Nadu, India
Cancer Institute-WIA, Chennai, Tamil Nadu, India.
BMJ Support Palliat Care. 2022 Dec;12(4):421-430. doi: 10.1136/spcare-2022-003833. Epub 2022 Jul 8.
Restriction of raw fruits and vegetables (neutropenic diet) is advised for patients receiving treatment for acute leukaemia in low-income and middle-income countries (LMICs) to reduce infections despite evidence to the contrary from high-income countries. We, therefore, conducted a randomised controlled trial to ascertain the efficacy of the neutropenic diet in an LMIC setting.
Patients aged 1-60 years receiving induction chemotherapy for acute leukaemia were randomised to a regular or neutropenic diet. The study's primary objective was to compare the incidence of major infections among patients receiving the two diets during induction chemotherapy. The secondary objectives were to compare stool microbial flora and induction mortality rates.
We randomised 200 patients, 98 patients to the regular diet arm and 102 to the neutropenic diet arm. Major infections occurred in 32 (32%) patients in the regular diet arm and 26 (25%) patients in the neutropenic diet arm (p=0.26). There were no statistically significant differences between patients receiving a regular diet versus neutropenic diet for blood culture positivity (n=6 vs 9), inotropic support (17 vs 12), mechanical ventilation (8 vs 5), third-line antibiotic use (28 vs 20), minor infections (12 vs 9), induction mortality (9 vs 4) and remission status (94% vs 94%). The stool culture on day 15 of induction grew multidrug-resistant bacteria in 38% of patients in the regular diet arm and 35% in the neutropenic diet arm (p=0.67).
A neutropenic diet did not prevent infections, reduce mortality or change stool microbial flora in patients with acute leukaemia.
在低收入和中等收入国家（LMICs），建议对接受急性白血病治疗的患者限制食用生的水果和蔬菜（中性粒细胞减少饮食）以减少感染，尽管高收入国家有相反的证据。因此，我们进行了一项随机对照试验，以确定在LMICs环境中中性粒细胞减少饮食的疗效。
年龄在1至60岁、接受急性白血病诱导化疗的患者被随机分配到常规饮食组或中性粒细胞减少饮食组。该研究的主要目的是比较诱导化疗期间接受两种饮食的患者中主要感染的发生率。次要目的是比较粪便微生物菌群和诱导死亡率。
我们将200名患者随机分组，98名患者分到常规饮食组，102名患者分到中性粒细胞减少饮食组。常规饮食组有32名（32%）患者发生主要感染，中性粒细胞减少饮食组有26名（25%）患者发生主要感染（p=0.26）。接受常规饮食与中性粒细胞减少饮食的患者在血培养阳性（分别为6例和9例）、使用血管活性药物支持（分别为17例和12例）、机械通气（分别为8例和5例）、使用三线抗生素（分别为28例和20例）、发生轻微感染（分别为12例和9例）、诱导期死亡率（分别为9例和4例）以及缓解状态（分别为94%和94%）方面无统计学显著差异。诱导期第15天的粪便培养显示，常规饮食组38%的患者培养出多重耐药菌，中性粒细胞减少饮食组为35%（p=0.67）。
中性粒细胞减少饮食并不能预防急性白血病患者的感染、降低死亡率或改变粪便微生物菌群。
