Chemotherapy-induced leukopenia is common following the administration of myelosuppressive agents such as taxanes or cyclophosphamide, which are used in BC treatment regimens. The occurrence of leukopenia may necessitate the interruption of therapy. However, these agents are not innocuous and can be associated with bone pain, allergic reactions, and capillary leak syndrome. Preliminary evidence show that acupuncture may offer benefit to BC patients by producing an increase in white blood cells and neutrophil counts.
A systematic review with a meta-analysis and trial sequential analysis (TSA) was conducted to determine the effects of acupuncture on chemotherapy-induced hematopoietic suppression, including blood count changes, in patients with BC. Randomized, controlled trials published in either English or Chinese, which included acupuncture (with/without electrical stimulation) as an intervention and which measured hematopoietic outcomes (e.g., WBCs, neutrophils), were included.
Study patients had to be at least age 18 years, on chemotherapy, and diagnosed with any stage of BC. TSA was conducted to determine if the sample size was sufficient to detect a specific outcome; in this case, it was the effect of acupuncture on leukopenia.
Databases included PubMed, Embase, the Cochrane Library, CINAHL Plus, Web of Science, the Airiti Library, and the China National Knowledge Infrastructure. They were searched until August 2021, when the effect size, heterogeneity, and bias were assessed.
A total of 10 articles that included a total of 650 participants met the study inclusion criteria. Of this group, 328 patients had received the intervention (i.e., any form of acupuncture) and 322 patients served as the control group. Random sequence generation was utilized to assess selection bias, which was low. However, other forms of bias were present among the trials.
The overall effect size for acupuncture improving WBCs and neutrophils in patients undergoing chemotherapy was 0.68 and 0.80, indicating a moderate and large effect size, respectively (P <.001). Heterogeneity was low (34% for WBCs; I2 = 34%) to nonexistent (0%; I2 = 0%) for the effects of acupuncture on neutrophils. The benefit of acupuncture on WBCs and neutrophils was significant for all forms of acupuncture. The TSA was supportive of the findings.
The authors speculated that acupuncture may increase the release of beneficial cytokines (e.g., stem cell factor) and neurochemicals and may regulate the microvascular system and immunosuppression, resulting in antitumor effects. Additionally, moxibustion may have anti-inflammatory effects. However, due to the retrospective nature of this study, these biomarkers were not assessed.
While the evidence is preliminary and coincides with the findings of several other small trials, acupuncture will not replace the need for GSFs in cases of severe leukopenia. Rather, these findings are hypothesis-generating. If supported by additional research, acupuncture may be a relatively benign method to help further promote hematopoietic status.
As patients search for more holistic approaches to care, pharmacists need to remain current on trends in alternative medicine when caring for patients with BC.
The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.
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