Acupuncture for reduction of symptom burden in multiple myeloma patients undergoing autologous hematopoietic stem cell transplantation: a randomized sham-controlled trial

Abstract

Purpose: Hematopoietic stem cell transplantation (HCT) is potentially curative for a number of hematologic malignancies, but is associated with high symptom burden. We conducted a randomized sham-controlled trial (RCT) to evaluate efficacy and safety of acupuncture as an integrative treatment for managing common symptoms during HCT.

Methods: Adult patients with multiple myeloma undergoing high-dose melphalan followed by autologous HCT (AHCT) were randomized to receive either true or sham acupuncture once daily for 5 days starting the day after chemotherapy. Patients and clinical evaluators, but not acupuncturists, were blinded to group assignment. Symptom burden, the primary outcome was assessed with the MD Anderson Symptom Inventory (MDASI) at baseline, during transplantation, and at 15 and 30 days post transplantation.

Results: Among 60 participants, true acupuncture produced nonsignificant reductions in overall MDASI core symptom scores and symptom interference scores during transplantation (P = .4 and .3, respectively), at 15 days (P = .10 and .3), and at 30 days posttransplantation (P = .2 and .4) relative to sham. However, true acupuncture was significantly more efficacious in reducing nausea, lack of appetite, and drowsiness at 15 days (P = .042, .025, and .010, respectively). Patients receiving sham acupuncture were more likely to increase pain medication use posttransplantation (odds ratio 5.31, P = .017).

Conclusions: Acupuncture was well tolerated with few attributable adverse events. True acupuncture may prevent escalation of symptoms including nausea, lack of appetite, and drowsiness experienced by patients undergoing AHCT, and reduce the use of pain medications. These findings need to be confirmed in a future definitive study.

Trial registration: NCT01811862.

Keywords: Acupuncture; Complementary therapies; Hematopoietic stem cell transplantation; Integrative medicine; Multiple myeloma; Symptom management.

Conflict of interest statement

Conflict of interest Dr. Giralt has received honoraria from Celgene, Takeda, Amgen, Jazz, and Sanofi; served in a consulting/advisory role for Celgene, Takeda, Sanofi, Jazz, Amgen, and Janssen; received research funding from Celgene and Takeda. Dr. Landau has received honoraria from Takeda; served in a consulting/advisory role for Onyx, Spectrum, Takeda, and Prothena; received research funding from Onyx. The remaining authors declare no competing financial interests.

Figures

Fig. 1

CONSORT diagram of study design and enrollment

Fig. 2

MDASI symptom scores from baseline to day 30 for patients in the acupuncture arm (green line), the sham arm (red line), and among a group of historical control patients receiving no acupuncture treatment (blue line).