By Dena McDowell, MS, RD

Bone marrow transplantation is a relatively new medical technique used in the treatment of certain blood cancers. People who suffer from aplastic anemia, certain forms of leukemia, and lymphoma or multiple myeloma may be candidates for transplantation. Patients undergoing transplantation have specific nutritional needs during their hospital stay and after as they continue to recover and regenerate their immune system. This article outlines the nutrition plan recommended for these patients.

Types of bone marrow transplantation

Patients may receive stem cells from either themselves or from a donor. Receiving your own cells is known as an autologus stem cell transplant. Receiving cells from a donor is known as an allogenic stem cell transplant. Each type of transplant carries its own risks; however, the autologus transplant usually has a quicker recovery time and less stringent dietary rules as compared to the allogenic transplant. In either case, it is important to follow safe food handling practices as well as practice prudence in food selection and preparation.

Nutrition while in the hospital

In either case of transplantation the patient's immune system is altered for a period of time. During this time the patient follows a neutropenic diet. As the cells engraft, the white blood cells return to normal and the neutropenic diet restriction is lifted. Patients often will have nausea and vomiting, taste alterations, and a heightened sense of smell during their hospital stay. The dietitian working with this patient will adjust the menu patterns accordingly to make foods palatable while trying to provide a high-protein balanced diet. Some patients will suffer from sores in the mouth and throat, making eating painful. In this case, following a liquid diet supplemented by nutritional shakes will help the patient meet his/her dietary needs. If the patient is unable to eat due to nausea, vomiting, diarrhea, or mouth sores, nutrition support either through a feeding tube or through a vein may be used temporarily to meet dietary needs. The patient's weight and labs, including protein status and electrolytes, will be analyzed by the dietitian and recommendations will be made to correct nutritional imbalances and well as prevent excessive weight loss.

Nutritional needs at home

Patients receiving transplants must follow strict dietary restrictions while at home to prevent food-borne illness.

Autogenic transplant guidelines

Patients need to avoid the following foods for 30 days post-transplant (or until the physician lifts the diet restrictions):

• Raw or undercooked meat
• Poultry
• Fish
• Game meats
• Eggs
• Hot dogs
• Sausage
• Tofu
• Cold smoked fish
• Lox
• Unpasteurized dairy products
• Deli items including meats and prepared foods
• Soft cheeses
• Unpasteurized honey
• Unrefrigerated cream-filled donuts
• Unpasteurized fruit and vegetable juices
• Raw nuts
• Popcorn
• Unwashed herbs
• Fruits and vegetables
• Alfalfa sprouts
• Unpasteurized beer.

It is also recommended that patients follow proper food safety including washing hands before food preparation, washing countertops, using separate cuts boards for meat and vegetables, cleaning the tops of cans before using, washing towels daily, defrosting all meat and poultry in the refrigerator before using, and freezing all leftovers for later use.

Allogenic transplant guidelines

Patients receiving donor cells need to follow the same precautions for 100 days post transplant (or until the physician lifts the diet restrictions). These patients also need to avoid well water (unless tested and free of coli forms) and food from street vendors or coffee carts.

Restaurant eating after a bone marrow transplant

Patients receiving either type of transplant need to exercise caution when eating in restaurants. If choosing to dine out, follow these simple rules:

• Pick restaurants with good reputations (check with your local health department for details).
• Avoid peak dining hours or ask to be seated away from high-traffic areas.
• Avoid salad bars and buffets.
• Ask how foods are prepared and make sure meats are cooked well before eating.
• Order items without condiments to ensure freshness.
• Avoid the condiment bar and ask for individually-wrapped packets instead.
• If taking carry-out, reheat before eating to ensure proper temperature.

Other things to consider after your transplant

Although the patient must follow strict dietary restrictions, it is also extremely important to eat well after transplant. Eating enough calories and protein will help promote a quicker healing time. Including whole grains, fruits, vegetables, meats or meat alternatives, cheese, and dairy every day will help meet daily needs. Log onto www.mypyramid.gov for more specific needs based on age, gender, and activity level. It is also recommended that patients take an iron-free daily complete multivitamin after transplant. Taking this supplement will help ensure the patient is meeting their dietary needs. If the patient is taking corticosteroids (often prescribed to prevent or treat graft-versus-host disease) then it is important to increase consumption of calcium because this type of medication can weaken the bones. If being treated for multiple myeloma, speak to the physician for calcium recommendations. If on corticosteroids, blood sugar levels may also be temporarily altered. Insulin or a diabetic diet may be warranted to help control blood sugar levels.

Conclusion: the right diet is key to success of the transplant

Stem cell transplantation carries specific dietary requirements in order to successfully regenerate the immune system. Following the dietary restrictions and working closely with a dietitian will help the patient meet his/her daily needs.