# Food safety during cancer treatment and the evidence against neutropenic diets

Source: https://onco.cc/protocols/food-safety-and-neutropenic-diet/  
OnCo record `food-safety-and-neutropenic-diet` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Strict lists of banned foods (the 'neutropenic diet') do not prevent infections in trials, in children or adults, and they make eating harder. What matters is ordinary food safety: clean hands and surfaces, raw meat kept apart, fruit and vegetables washed, meat and eggs cooked through, and no unpasteurised milk or cheese, mouldy food or unsafe water. Transplant teams may differ.

## Summary

The 2025 POGO guideline, endorsed by the Children's Oncology Group, reviewed 8 randomised trials and suggests that food restrictions not be routinely used to prevent infection in children with cancer (conditional, moderate quality) or after autologous or allogeneic HCT (conditional, low quality), with a good practice statement to follow safe food handling, storing, preparation and consumption as set by applicable health authorities. ASCO (2022) does not recommend neutropenic diets to prevent infection in adults during active treatment. Meta-analysis of 6 randomised trials (Ma 2022) found no reduction in infection (risk ratio 1.13, 95% CI 0.97 to 1.31) or mortality, and a 2025 systematic review of 5 trials in adults having high-dose therapy found no benefit and a tendency to worse nutritional status. One older trial in 153 adults with AML or high-risk MDS found fewer bloodstream infections with restrictions; the POGO panel judged it indirect for children.

The older CDC/IDSA/ASBMT HCT guideline (2009) still recommends a low-microbial diet before engraftment (CIII, noting evidence is lacking) and a food-safety diet after it until immunosuppression stops; its safe handling advice (separate raw meat, wash produce, cook meat to a measured internal temperature, refrigerate leftovers within 2 hours) is what most food safety teaching uses. The items safe handling advice agrees on everywhere are unpasteurised milk and cheese, undercooked eggs and meat, mouldy food and possibly contaminated water.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: neutropenic diet; low-microbial diet; low-bacterial diet; clean diet; food restrictions during chemotherapy; food safety neutropenia; protective diet
- Tags: protocol; neutropenic-diet; food-safety; paediatric

## Connected records

- protocols: [Diet, alcohol and weight during cancer treatment](https://onco.cc/protocols/diet-alcohol-and-weight-during-cancer-treatment/), [Protective measures and daily life during neutropenia: hand hygiene, visitors, pets, plants, school and swimming](https://onco.cc/protocols/neutropenic-precautions-and-daily-life/)
- cancers: [Acute lymphoblastic leukaemia](https://onco.cc/cancers/all-leukemia/), [Acute myeloid leukaemia](https://onco.cc/cancers/aml/), [Childhood cancers (all types)](https://onco.cc/cancers/childhood-cancers/)
- fronts: [Diet, Exercise & Lifestyle](https://onco.cc/fronts/nutrition-lifestyle/), [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- technologies: [Allogeneic stem cell transplantation](https://onco.cc/technologies/allogeneic-hsct/), [Autologous stem cell transplant (high-dose therapy)](https://onco.cc/technologies/autologous-stem-cell-transplant/)
- companies: [Children's Oncology Group (COG)](https://onco.cc/companies/childrens-oncology-group/)
- institutions: [American Society of Clinical Oncology (ASCO)](https://onco.cc/institutions/asco/)
- terms: [Febrile neutropenia](https://onco.cc/terms/febrile-neutropenia/), [Neutropenia](https://onco.cc/terms/neutropenia/)

---
JSON: https://onco.cc/api/v1/entities/food-safety-and-neutropenic-diet.json