Stem Cell Transplant Diet

These pages list the foods that are safe or not safe to eat when your immunity is low and/or when you may be at high risk for foodborne sickness. These diet guidelines should be used before and after therapy. Please check with your doctor, nurse, or dietitian if you have questions about the diet or safe food preparation. They can also tell you when you no longer need to follow these guidelines. Most of the time, it is suggested that:

• Autologous transplant patients: Stay on this plan for the first 3 months after transplant
• Allogeneic transplant patients: Stay on this plan until off all immunosuppressive therapy

General Tips

Fresh fruits and vegetables are allowed on this diet. Be sure to check for and avoid those with bruises and/or broken skins. It is important that fresh produce is washed well (rinsed under clean, running water before use, including produce that is to be cooked or peeled,i.e., bananas, oranges, melon).

Avoid raw or rare-cooked meat, fish, and eggs. Meat should be cooked to the “well done” stage. All eggs should be fully cooked (no runny yolks).

Avoid foods that are visibly rotten and/or have mold. Do not use food that smells bad.

Do not keep leftovers for more than 3 days.

Do not share food or drinks with other people, even family members.

All dairy products must be pasteurized.

Wash hands with warm water and soap before handling food. Wash all sinks, counters, handles, cutting boards and cutting utensils very well.

Keep hot food hot and cold food cold.

Tips for Dining Out

• Eat early to avoid crowds.
• Ask that food be made fresh in fast-food restaurants.
• Avoid raw fruits and vegetables when dining out; save these items for home, where you can wash and prepare them safely.
• Do not eat salsa or other condiments that are not refrigerated and are used by many people at a restaurant.
• Ask for single-serving condiment packages. Do not use public self-serve condiment containers.
• Avoid salad bars, delicatessens, buffets, smorgasbords, potlucks, and sidewalk vendors. These are high-risk food sources due to the risk of improper food storage or holding temperature and poor hygiene by food handlers.
• Check the general condition of the restaurant. Are the plates, glasses, and utensils clean? Are the restrooms clean and stocked with soap and paper towels? How clean the restaurant looks may suggest the level of care taken while making the food.

Foods to Choose or to Avoid

Drinks

Drinks to choose (safe):

• Instant and brewed decaf or regular coffee and tea
• Single serving cans or bottles of carbonated drinks
• Tap water andice made from tap water
• Bottled water
• Boiled well water
• Brewed herbal teas
• All canned, bottled, and powdered drinks and sports drinks
• Commercial nutritional supplements, liquid, and powdered

Drinks to avoid (unsafe):

• Cold brewed tea or sun tea
• Un-boiled well water
• Non-pasteurized fruit and vegetable juices
• Wine*
• Unpasteurized beer*

*All alcoholic beverages should only be used with physician approval

Bread, grain, and cereal products

Foods to choose (safe):

• All types of bread, rolls, English muffins, fruit muffins, bagels, sweet rolls, donuts
• Waffles
• French toast, pancakes
• Potato chips, corn chips, tortilla chips, pretzels, popcorn, crackers, melba toast
• All types of cooked and ready-to-eat cereals
• Cooked grains, rice, and pasta, such as noodles, macaroni, and spaghetti
• Cooked white or sweet potatoes and yams, French fries, tater tots, hash browns

Foods to avoid (unsafe):

• Raw oats or uncooked grains/cereals
• Uncooked pasta salad or potato salad with raw vegetables or eggs
• Breads, rolls, and/or pastries served in self-service bins

Dairy products

Foods to choose (safe):

• Pasteurized milk: Fat-free milk, 2% milk, whole milk, buttermilk, or chocolate milk
• Sour cream
• Cream cheese
• Commercial eggnog
• Commercial supplements such as instant breakfast drinks
• Commercial frozen and homemade milkshakes
• Pasteurized, refrigerated, or frozen whipped topping
• Pasteurized yogurt

Foods to avoid (unsafe):

• Unpasteurized milk or yogurt
• Raw milk
• Eggnog made with raw eggs

Cheese

Foods to choose (safe):

• Commercially packaged cheese (e.g.,American, Swiss, Parmesan, Mozzarella, Cheddar, Monterey Jack)
• Pasteurized cottage cheese, ricotta cheese
• Processed cheese (such as, Velveeta®)
• Pre-packaged cheeses

Foods to avoid (unsafe):

• Unpasteurized and raw milk cheese
• Cheeses with molds (e.g., Blue, Gorgonzola, Roquefort, and Stilton cheeses)
• Soft cheeses (e.g., Brie, Camembert, Feta, Farmer's cheese)
• Mexican-style cheeses, such as queso fresco and queso Blanco
• Sliced cheeses from the deli

Desserts (and other sweets)

Foods to choose (safe):

• Cakes, pies, and cookies
• Baked custard, pudding, and gelatin
• Shelf stable cream-filled cupcakes and fruit pies
• Commercial ice cream, sherbet, fruit ice, and ice pops (such as Popsicles®)
• Refrigerated cream filled pastries and desserts
• Jam and jelly
• Pasteurized honey and syrup
• Chewing gum, candy, chocolate

Foods to avoid (unsafe):

• Cream filled pastries that are not refrigerated
• Unbaked cookie dough
• Unpasteurized honey/honey in the comb

Fats

Foods to choose (safe):

• Refrigerated butter, margarine, or lard
• Cream cheese, sour cream, salad dressings, or mayonnaise (refrigerate after opening)
• Vegetable oil
• Cooked gravies andsauces
• Shortening used in cooking
• Non-dairy creamers
• Nuts (dry roasted)
• Commercially packaged peanut butter

Foods to avoid (unsafe):

• Avocado dressing
• Fresh salad dressing that has aged cheese, raw eggs, or fresh herbs
• Raw (non-roasted) nuts
• Roasted nuts in shell
• Freshly made peanut, almond, cashew, or other nut butters

Fruits and Fruit Juices

Foods to choose (safe):

• Canned fruits and juices
• Pasteurized frozen juices
• Pasteurized cider and apple juice
• Fresh fruits washed in clean running water. Includes those with thick skins such as bananas, melons.
• Frozen fruits
• Dried fruits

Foods to avoid (unsafe):

• Unwashed raw fruit
• Unpasteurized fruit juices
• Fresh fruit salsa found in grocery store refrigerator case

Meats

Foods to choose (safe):

• Well-cooked meat, fish, poultry, or meat substitutes
• Single-serving cooked, canned, or frozen products (nothing raw)
• Canned tuna or chicken (with no raw vegetables)
• Cooked baked beans and all other cooked legumes, dried beans, casseroles, stews, and entrees
• Frozen entrees
• Pasteurized or cooked tofu
• Eggs, well-done so that both the white and the yolk are firm
• Pasteurized egg substitutes (such as, Egg Beaters®) and powdered eggs
• Canned and homemade soup (heated well)

Foods to avoid (unsafe):

• Rare or medium-rare, cooked meat, fish, or poultry
• Raw tofu
• Cold cuts or meats from delicatessens
• Cold meat or poultry
• Raw eggs
• Eggs not well-cooked such as sunny-side-up (runny yolk)
• Cold soups and gazpacho, all miso products such as paste and soup
• Sushi, sashimi
• Smoked or pickled salmon or other fish
• Refrigerated pates and meat spreads
• Hard cured salami in natural wrap
• Tempe (tempeh) products

Vegetables

Foods to choose (safe):

• All well-cooked canned, frozen,or fresh vegetables and cooked potatoes
• Fresh, well washed herbs and dried spices (added to raw or cooked foods)
• Fresh vegetables cleaned under clean, cold running water
• Canned vegetable juices
• Shelf stable bottled salsa

Foods to avoid (unsafe):

• Unwashed vegetables and herbs
• Salads from delicatessens
• Fresh sauerkraut
• Fresh salsa found in grocery refrigerator case
• All raw vegetable sprouts (alfalfa sprouts, clover sprouts, mung bean sprouts, etc.)

Miscellaneous

Foods to choose (safe):

• Salt, granulated sugar, brown sugar
• Jams, jellies, syrups
• Commercial (heat treated) honey
• Ketchup, mustard, barbeque sauce, soy sauce
• All other herbs or spices added during cooking
• Low-salt seasoning added during cooking
• Commercial pickles packaged in jars or cans
• Olives
• Pickles, pickle relish
• Candy, gum

Foods to avoid (unsafe):

• Spices, herbs, or seasonings added to foods after cooking (except for allowed items)
• Un-canned or home-canned pickles and Kosher pickles
• Hollandaise sauce
• Raw, unpasteurized honey or non-treated honey; honey in the comb
• Herbal and nutrient supplement preparations
• Brewer’s yeast if uncooked
• Foods from shared bins in grocery stores
• Foods from street vendors

Updated January. 2023

Adapted from:

Seattle Cancer Care Alliance, Diet Guidelines for Transplant Patients

The Academy of Nutrition and Dietetics, Nutrition Therapy for Individuals with Suppressed Immunity