General MM,   Patients eligible for transplant

Acupuncture may reduce disease symptoms in MM patients undergoing transplant

Common side-effects after Autologous Hematopoietic Stem Cell Transplantation (AHSCT) include pain, poor appetite, fatigue, insomnia, nausea, vomiting and diarrhoea, and are typically managed with pharmacological interventions. However, medicines to control these symptoms can also cause further side-effects leading to a more problematic recovery and reducing patient quality of life.

On 17th September 2017, Gary Deng from the Memorial Sloan Kettering Cancer Center, New York, and colleagues, published a paper in Support Care Cancer to report their findings following a study to explore the use of acupuncture in the management of side-effects after AHSCT in patients with Multiple Myeloma (MM).  The authors investigated the use of acupuncture as an integrative non-pharmacological method of improving patient symptoms using a randomized sham-controlled trial.

The trial took place at Memorial Sloan Kettering Cancer Center, New York, between May 2013 and January 2016 and was subject- and evaluator-blind. Patients included in the study (n=60) had a diagnosis of MM and were treated with high-dose melphalan followed by autologous peripheral blood HCT. Patients were randomized to receive either true- or sham-acupuncture. The primary outcome of symptom burden was assessed using the MD Anderson Symptom Inventory (MDASI) and was measured at baseline, during transplantation and on Day 15 and 30 post-transplantation.

Key Findings
  • Patients (pts) received a stem cell infusion on Day 0 and conditioning chemotherapy on Day 2
  • Pts received either true (n = 29) or sham (n = 31) acupuncture on Day 1 for five days (treatment time = 20 min)
  • Overall symptom scores were reported as lower in the true-acupuncture group but was not statistically significant in comparison to sham-acupuncture
  • Mean MDASI core overall symptoms score:
    • True- vs sham-acupuncture = 1.82 (SD 1.91, 95% CI 1.10–2.55) vs 98 (SD 1.35, 95% CI 1.48–2.47)
  • Days 0–5 MDASI scores:
    • True- vs sham-acupuncture = 1.23 (1.24) vs 66 (1.14) (95% CI, -0.06–0.23, P = 0.4)
  • Day 15 follow-up MDASI scores:
    • True- vs sham-acupuncture = 1.34 (1.49) vs 10 (1.52) (95% CI, -1.03–0.09, P = 0.10)
  • Day 30 follow-up MDASI scores:
    • True- vs sham-acupuncture =1.15 (1.10) vs 67 (1.40) (95% CI, -0.92–0.18, P = 0.2)
  • Nausea, lack of appetite and drowsiness were significantly reduced in the true-acupuncture group (P < 0.05 for all individual symptoms)
  • Analgesic use was significantly lower in patients receiving true- vs sham-acupuncture, odds ratio = 5.31, 95% CI 1.35–20.93
  • Acupuncture was well tolerated with no significant difference in the number of adverse events
Conclusion

The authors concluded that even though there was no significance in the overall symptom scores between the true- and sham-acupuncture groups, it was worth noting that there were statistically significant improvements in nausea, appetite and drowsiness, as well as reduced use of pain medication within the true-acupuncture group. Since the treatment was safe and well tolerated by patients, the study suggests that acupuncture could potentially improve patient quality of life and symptom burden after AHSCT. Further investigation into this integrative treatment in a larger sample size may be useful to further evidence the benefit of acupuncture in these patients.

 
References
  1. Deng G. et al. Acupuncture for reduction of symptom burden in multiple myeloma patients undergoing autologous hematopoietic stem cell transplantation: a randomized sham-controlled trial. Support Care Cancer. 2017 Sep 17. DOI: 10.1007/s00520-017-3881-7. [Epub ahead of print]
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