Enteral nutrition (EN) may be contraindicated in the early post-transplant period in adult patients with hematopoietic cell transplants because of:

• A. Increased incidence of sinusitis with enteral feedings
• B. Lack of benefit from enteral feedings in allogeneic patients
• C. Gastrointestinal toxicities related to the conditioning regimen
• D. Improved survival seen in autologous patients receiving parenteral nutrition

Answer: (D)

In the early post-transplant period, the gut is often severely damaged from the conditioning regimen, mucositis, and immune suppression. Feeding by the gut can be poorly tolerated and may increase risks of feeding intolerance and infection if the gut barrier is compromised. The reason this option stands out is that in autologous transplant patients, parenteral nutrition has been associated with improved survival in this early recovery phase, making enteral feeding less favorable during that specific window. By delivering nutrition intravenously, the gut is bypassed while the patient recovers, which can support faster healing and reduce GI-related complications. The other choices don’t capture this practical clinical nuance as strongly: sinusitis isn’t a main driver of EN decisions; EN is generally beneficial in many transplant settings; GI toxicity from conditioning is a concern but doesn’t by itself explain why EN would be contraindicated in this context as clearly as the PN survival data does.