title: The prophylactic use of Chinese herbal medicine for chemotherapy-induced leucopenia in oncology patients: a systematic review and meta-analysis of randomized clinical trials.
abstract: 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.
authors.affiliation: Department of Nutrition and Food Hygiene, Hebei University School of Public Health, Baoding, Hebei Province, China.
authors.forename: L X
authors.initials: LX
authors.lastname: Ma
authors.forename: P
authors.initials: P
authors.lastname: Ai
authors.forename: H
authors.initials: H
authors.lastname: Li
authors.forename: J
authors.initials: J
authors.lastname: Vardy
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D044466:Asian People; D064146:Chemotherapy-Induced Febrile Neutropenia / Q000517:prevention & control*; D004365:Drugs, Chinese Herbal / Q000009:adverse effects / Q000627:therapeutic use*; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use*; D006301:Health Services Needs and Demand; D006801:Humans; D007958:Leukocyte Count; D009369:Neoplasms / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic
chemical_list: D000970:Antineoplastic Agents; D004365:Drugs, Chinese Herbal; D016179:Granulocyte Colony-Stimulating Factor