Meta-Analysis
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Meta-Anal. Jun 26, 2015; 3(3): 163-180
Published online Jun 26, 2015. doi: 10.13105/wjma.v3.i3.163
Is the traditional Chinese medicine helpful for patients with hematologic malignant diseases? A meta-analysis of randomized controlled trials
Cheng-Liang Qian, Fei Yan, Yan-Zhi Song, Dong Li, Ke-Zhou Dong, Yi-Min Zhu
Cheng-Liang Qian, Department of Traditional Chinese Medicine, Nanjing BenQ Medical Center, Nanjing Medical University, Nanjing 021000, Jiangsu Province, China
Fei Yan, Department of Medical Oncology, Jiangsu Cancer Hospital, Nanjing 021000, Jiangsu Province, China
Yan-Zhi Song, Dong Li, Department of Hematology, Nanjing BenQ Medical Center, Nanjing Medical University, Nanjing 021000, Jiangsu Province, China
Ke-Zhou Dong, Yi-Min Zhu, Department of Respiration, the 2st Jiangsu Province Hospital of TCM, Nanjing University of Chinese Medicine, Nanjing 021000, Jiangsu Province, China
Author contributions: Song YZ conceived and designed the study, searched and selected trials for inclusion, assessed methodological quality of included trials, extracted data, performed the statistical analysis and wrote the review; Qian CL searched trials, selected trials for inclusion, assessed methodological quality of included trials and extracted data; Yan F searched and selected trials for inclusion and wrote the review; Li D, Dong KZ and Zhu YM wrote and revised the review.
Supported by The Six Peak Talent Program of Jiangsu Province, No. 2009-47-D.
Conflict-of-interest: There is no conflict of interest reported.
Data sharing: No.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Yan-Zhi Song, Department of Hematology, Nanjing BenQ Medical Center, Nanjing Medical University, 71# Hexi Street, Jianye District, Nanjing 021000, Jiangsu Province, China. yandgics@126.com
Telephone: +86-25-52238800 Fax: +86-25-52238800
Received: October 19, 2014
Peer-review started: October 21, 2014
First decision: December 26, 2014
Revised: April 13, 2015
Accepted: May 5, 2015
Article in press: May 6, 2015
Published online: June 26, 2015
Processing time: 253 Days and 18.7 Hours
Abstract

AIM: To evaluate the efficacy of traditional Chinese medicine (TCM) for the treatment of hematologic malignant diseases.

METHODS: We searched the Cochrane CENTRAL, PubMed, Embase, Web of Science, AMED, CNKI, Wanfang Platform; China Sinomed and the clinical trial registry web sites and Googlescholar electronically up to June 19th, 2014 and hand searched related publications. Only randomized controlled trials (RCTs) researching on whether TCM as the adjuvant treatment improved the effect for hematologic malignant diseases were included. Two reviewers extracted data and evaluated the studies independently. Pooled risk ratios (RR) were calculated as outcome measures. Our primary outcomes were the overall response (OR) rate.

RESULTS: We retrieved 13143 references and included 11 RCTs involved 891 participants after screening. Because the non-significant heterogeneity we used the fixed effect model to combine data and TCM had a significantly higher OR and CR (complete response) rates than the control [RR = 1.17, 95%CI: (1.10, 1.25), P < 0.00001; RR = 1.24, 95%CI: (1.11, 1.37), P < 0.0001, respectively]. Only three studies included in the survival rate analysis. We combined them with random effects model and there was no significant difference between the TCM and control arms. Because of the low heterogeneity we used the fixed effect model to combine the non-hematologic adverse effects (AEs) data. Our results showed that TCM significantly decreased non-hematologic AEs rates we researched, the gastrointestinal reaction [RR = 0.50, 95%CI: (0.37, 0.68), P < 0.0001], liver and/or kidney injury [RR = 0.37, 95%CI: (0.26, 0.53), P < 0.00001] and heart injury [RR = 0.24, 95%CI: (0.09, 0.68), P = 0.007]. Additionally, TCM had a trend to decrease the infection rate [RR = 0.16, (0.02, 1.12), P = 0.07], but not statistically significantly.

CONCLUSION: TCM increases OR and CR rates for hematologic malignances and reduces treatment associated serious non-hematologic AEs. Therefore, TCM should be included in the treatment of hematologic malignances.

Keywords: Hematologic malignant disease; Leukemia; Lymphoma; Chinese medicine

Core tip: We pooled all the studies complied to our inclusion criteria that were retrieved by extensively searching the related databases, journals and websites. Our result suggested that adding traditional Chinese medicine (TCM) increased overall response and complete response rates for malignant hematologic diseases treatment. Although it was based on the evidence of low level of GRADE quality, our result demonstrated that TCM reduced treatment associated serious non-hematologic adverse effects (AEs). Furthermore, considering the rare AEs and drugs interactions, TCM should be included in the hematologic malignances treatment, at least for adult acute leukemia.