Lack of Effectiveness of Neutropenic Diet and Social Restrictions as Anti-Infective Measures in Children With Acute Myeloid Leukemia: An Analysis of the AML-BFM 2004 Trial

Abstract

Purpose Although nonpharmacologic anti-infective measures are widely used in children treated for acute myeloid leukemia (AML), there is little evidence of their effectiveness. Patients and Methods We analyzed infectious complications in children during intensive treatment of AML according to the AML-BFM 2004 trial and surveyed sites on institutional standards regarding recommended restrictions of social contacts (six items), pets (five items), and food (eight items). A scoring system was developed with a restriction score for each item. Multivariable Poisson regression adjusted for sex, age, weight group, risk stratification, and prophylactic antibiotics was used to estimate the impact of the restrictions on the incidence ratios of fever of unknown origin, bacteremia, pneumonia, and gastroenteritis. Results Data on recommendations of nonpharmacologic anti-infective measures and infectious complications were available in 339 patients treated in 37 institutions. Analyses did not demonstrate a significant benefit of any of the restrictions regarding food, social contacts, and pets on the risk of fever, bacteremia, pneumonia, and gastroenteritis. In contrast, age, weight group, risk stratification, and nonabsorbable antibiotics had some influence on infections complications. Conclusion The lack of effectiveness of dietary restrictions and restrictions regarding social contacts and pets should result in reconsideration of anti-infective policies.

Differences in infection prophylaxis measures between paediatric acute myeloid leukaemia study groups within the international Berlin–Frankfürt–Münster (I‐BFM) study group

“…Evidence supporting food restrictions in patients with cancer in general is, however, ambiguous and limited to small studies (van Dalen et al , ). A recent study among different hospitals worldwide, many of them affiliated to a study group included in our survey, showed no beneficial effects of strict food regimens during AML treatment (Tramsen et al , ). Multiple groups emphasize limiting visits to day‐care and (indoor) crowded places.…”

Revisiting nutritional support for allogeneic hematologic stem cell transplantation—a systematic review

“…29 This result in combination with previous similar observations argues for a less strict use of neutropenic diets. [59][60][61][62][63][64][65][66][67] Therefore, focusing on safe food-handling practices and retaining restrictions on raw meat or dairy products, as well as apparent fungal components as mold cheese, but allowing raw fruit and vegetable if properly washed and/or peeled seems adequate. 61,68 Again, only adequately powered randomized controlled studies will give better evidence on effectiveness of food safety guidelines.…”

Strategies for reducing the treatment‐related physical burden of childhood acute myeloid leukaemia – a review

“…Other general measures, such as diet and avoiding social contacts and pets, are not proven to be effective (Tramsen et al, 2016). In general, one should distinguish general measures from interventions that are more dependent on type of microorganism.…”

“…Strict hygiene has been proven to prevent transmission of infections from patient to patient in the hospital setting. Other general measures, such as diet and avoiding social contacts and pets, are not proven to be effective (Tramsen et al, 2016). Given the social consequences, it is doubtful whether it is justified to recommend them without the evidence supporting it.…”