In patients undergoing hematopoietic stem cell transplantation, current evidence comparing enteral nutrition to parenteral nutrition shows which of the following?

• A. Enteral nutrition consistently improves survival over parenteral nutrition.
• B. Parenteral nutrition has been shown to reduce infection rates compared with enteral nutrition.
• C. There is insufficient data to establish a clear benefit; one study suggested parenteral nutrition may increase survival in allogeneic patients.
• D. Enteral nutrition increases mortality compared with parenteral nutrition.

Answer: (C)

In hematopoietic stem cell transplantation, the evidence comparing enteral nutrition to parenteral nutrition is not definitive. The studies done so far are limited and results are inconsistent, so there isn’t a clear, replicated benefit shown for either route. While enteral nutrition is generally favored for preserving gut integrity and reducing infection risk in many settings, in HSCT the data don’t establish a clear advantage, and at least one study in allogeneic recipients suggested parenteral nutrition might be associated with improved survival. Because of the lack of consistent, robust data, we can’t conclude a definitive benefit for either approach, highlighting the need for more comprehensive trials.