The prophylactic use of Chinese herbal medicine for chemotherapy-induced leucopenia in oncology patients: a systematic review and meta-analysis of randomized clinical trials.

OBJECTIVE: We performed a systematic review and meta-analysis to explore the clinical application of Chinese herbal medicine (CHM) for chemotherapy-induced leucopenia and to evaluate its effectiveness and safety.
METHODS: We included randomized clinical trials (RCTs) with no limitation of publication type or language. Participants were cancer patients undergoing chemotherapy. Trial designs included comparisons of CHM with granulocyte colony-stimulating factor, supportive treatments for leucopenia, and/or placebo. Main outcomes were white blood cell count and incidence of leucopenia. Screening, data extraction, and analysis were conducted according to the PRISMA guidelines.
RESULTS: Eighty-three RCTs (n = 8,012) met the inclusion criteria. Fifteen Chinese patent medicines and 47 different modified formulas were used as prophylaxis for chemotherapy-induced leucopenia. Compared with no treatment, CHMs were shown to decrease the incidence of leucopenia (odds ratio (OR) -0.23 [-0.20, -0.27]), P < 0.00001), with the number needed to treat (NNT) -3.45 [-3.13, -3.85]. Subgroup analysis suggested a prophylactic benefit for white blood cell counts with Fufang E-jiao Jiang, Diyu Shengbai Pian, combination Huangqi and Shengmai Zhusheye, and Fuzhong Shengbai Fang for patients undergoing chemotherapy. No serious adverse events were reported. Only three articles (3/83, 4 %) were rated as having adequate methodological quality with a low level of bias. Funnel plots were asymmetrical.
CONCLUSIONS: Some CHMs may be efficacious in the treatment of chemotherapy-induced leucopenia, but the majority of reviewed studies were of poor quality. Results need to be confirmed in rigorously conducted high-quality trials, including pharmacokinetic studies to ensure that there are no interactions between the CHM agent and chemotherapy.