The article by Fox and Freifeld presents a comprehensive history of the rationale for the neutropenic diet, along with important studies of this diet. At our institution, we initiated the protective environment in the 1960s for acute leukemia patients. It consisted of isolation tents and laminar air flow along with nonabsorb-able antibiotics and sterilized food, which our patients did not find very palatable. [1] Over the years the protective environment has evolved from a strict sterile environment to clean technique with isolation gowns, shoe covers, caps and masks, and extra HEPA filtration for all of our newly diagnosed AML (acute myelocytic leukemia) patients Over 50 years Of age and ALL (acute lym-phocytic leukemia) patients older than 60 years. These precautions are still being used to reduce the incidence of, and mortality from, fungal infections and gram-negative bacteremia in induction patients.
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