Effect of Omega-3 in Patients Undergoing Bone Marrow Transplantation: A Narrative Review

Reviewer 1

The introduction section can be reduced

We appreciated this suggestion. We revised the introduction by streamlining the content while maintaining clarity and completeness.

My suggestion is to integrate the text with a table in which the authors outline the introduction of fatty acids during the transplant,

We acknowledged this valuable recommendation. A table summarising the introduction and role of fatty acids during the transplantation process was incorporated to enhance clarity and readability.

We removed the figure in order not to create overlap and integrated a table in which we kept part of the images as “icons”.

We hope that these changes make the text clearer now

The authors should report data on the improvement of immunological reconstitution (both in terms of accelerated reconstitution and reduced incidence of infectious events).

Thank you for your valuable comment, we have made changes to section 3.3.

First of all, we have revised the section title by integrating it with “Immunomodulation” since the section also explains the effects of supplementation

We have examined the included studies and integrated the data available in the section. Unfortunately, as expressed in the limitations of the study, the data are heterogeneous and not available as text in the individual manuscripts or in aggregate form, so we could only integrate those available.

Reviewer 2

I would just further specify in the text what the differences in effects were between arms. For example, in line 228 it is written that omega 3s improved long-term survival in an RCT, but it is not written what the median survival was, or what the 2-year survival was, and the like.

Thank you for your valuable comment, in accordance with the suggestions of reviewer 1 that we have specified and clarified in section 3.3 the data regarding the effects of Omega-3

We have examined the included studies and integrated the data available in the section. Unfortunately, as expressed in the limitations of the study, the data are heterogeneous and not available as text in the individual manuscripts or in aggregate form, so we could only integrate those available.

In the table the last row is incorrectly formatted -- it is all in bold and some of the text appears in a header.,

We acknowledged this formatting issue and corrected it to ensure consistency and proper readability of the table.

Reviewer 3

Fig 1 does not really look well, can you redo?

We appreciated this feedback. In agreement with reviewer 1 we have removed the figure and integrated a table in which we have kept part of the images as “icons”

We hope that these changes will make the text clearer now

In the list of hematological diseases, multiple myeloma is not included. Was there a reason these patients were excluded from the study?

Thank you for the valuable comment, we have inserted the multiple myeloma in the text of the introduction

It seems somewhat odd that 2607 articles are published but only 5 studies were analyzed....

Is there a reason why the authors included the grey literature in the initial search?

Thank you for the comment, we have mapped all the available literature by extending the search to the main scientific databases and also integrating grey literature sources that included peer-reviewed manuscripts. However, as previously highlighted by other authors (https://www.ncbi.nlm.nih.gov/books/NBK553969/#ch24.Sec11 ), the literature to date is poor and this has been underlined in the limits of the review and in the future research perspectives

 349 articles were irrelevant - why?

 The 349 articles were excluded due to not meeting eligibility criteria, such as irrelevance to omega-3 supplementation in HSCT, lack of clinical outcomes, or inappropriate study design. This exclusion process was clarified in the manuscript.

the analyzed studies seem to have very few patients. Do you think the results are then relevant?

We acknowledged the small sample sizes as a limitation. However, given the complexity of HSCT studies and the limited availability of trials in this specific field, these results remained relevant as preliminary evidence. This point was highlighted in  the discussion section while calling for further large-scale studies.