Efficacy and safety of acupuncture therapy for leukopenia after chemotherapy or radiotherapy: A systematic review and meta-analysis

Introduction: Acupuncture-Moxibustion Therapy (AMT) has been used to treat leukopenia associated with cancer treatment. This systematic review and meta-analysis aimed to assess the clinical efficacy, safety, and degree of evidence of AMT in the treatment of post-chemoradiotherapy leukopenia. Methods: Four English databases (The Cochrane Library, PubMed, EMBASE, Web of Science) and four Chinese databases (Chinese Biomedical Database (CBM), China National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP), and WanFang Database) were searched from inception to February 6, 2023 for randomized controlled trials (RCTs) regarding post-chemoradiotherapy leukopenia with AMT. Two authors extracted data and assessed the quality of trials through the Cochrane risk of bias tool 2.0 independently. All meta-analysis was performed using Review Manager 5.4.1 and GRADE was usually used to measure the certainty of evidence. Results: The analysis included 18 RCTs with 1,377 patients. The results showed that in treating postchemoradiotherapy leukopenia, AMT is more effective compared to Chinese herbal medicine (CHM) (e.g., the effective rate: risk ratio (RR) =1.33, 95 % confidence interval (CI) 1.16 to 1.53, 3 RCTs, 349 cases; the white blood cell count (WBC): standardized mean difference (SMD) =1.03, 95 %CI 0.04 to 2.01, 2 RCTs, 148 cases), experimental synthetic drugs (ESDs) (e.g., the effective rate: RR =1.35, 95 %CI 1.13 to 1.61, 3 RCTs, 184 cases; the WBC: SMD =1.43, 95 %CI 1.21 to 1.65, 3 RCTs, 244 cases). AMT in combination with myeloid growth factors (MGFs) significantly improved the effective rate (RR =1.21, 95 %CI 1.09 to 1.35, 3 RCTs, 187 cases) and WBC (SMD =1.86, 95 %CI 1.56 to 2.17, 2 RCTs, 117 cases) compared to MGFs. However, there are no data to support the benefits of AMT or in combination with drugs in terms of Karnofsky performance status scores. The certainty of the overall evidence is very low due to the small sample sizes and poor quality of the included RCTs. Conclusions: Very low certainty evidence suggests that AMT may be an effective complementary therapy for postchemoradiotherapy leukopenia. The present evidence does not support a definitive safety profile for AMT. However, the quality of the current studies are low, and these conclusions need to be further validated by conducting more high quality RCTs.