The use of complementary and alternative medicine in the Middle East for managing neutropenia in cancer patients: A systematic review and meta-analysis of randomized controlled trials.

e23411 Background: Neutropenia, a common life-threatening complication of systemic cancer therapies, heightens infection risk, delays treatment, and impairs quality of life. In the Middle East, complementary and alternative medicine (CAM) is widely used alongside conventional oncology care, yet robust clinical evidence for its role in neutropenia management remains scarce. Methods: A PRISMA 2020-compliant systematic review and meta-analysis of randomized controlled trials (RCTs) was performed. Comprehensive literature searches were conducted in Scopus, CENTRAL, MEDLINE, and Embase. Eligible studies included cancer patients undergoing systemic therapy, complementary and alternative medicine (CAM) interventions relevant to the WHO Eastern Mediterranean Region, and neutropenia-related outcomes. Results: A total of 10,263 records were identified across databases and trial registers, including Scopus (n = 4,394), CENTRAL (n = 2,497), MEDLINE (n = 1,805), and Embase (n = 1,567). After removal of 2,711 duplicates (2,698 via Covidence and 13 manually), 7,552 records were screened, of which 7,304 were excluded. The 230 full-text articles were assessed for eligibility, and 7 randomized controlled trials (RCTs) met the inclusion criteria for present meta-analysis. Complementary and alternative medicine (CAM) interventions significantly improved absolute neutrophil count (SMD = 0.64, 95% CI 0.32-0.96; p < 0.001) and reduced the risk of neutropenia-related complications (OR = 0.53, 95% CI 0.34-0.83; p = 0.005). CAM use was also associated with fewer infections and reduced treatment interruptions. No serious adverse events or clinically relevant herb-drug interactions were reported, and the overall risk of bias across included studies was low to moderate. Conclusions: CAM therapies commonly used in the Middle East appear to be safe and potentially effective adjuncts for managing neutropenia in cancer patients. Larger, high-quality RCTs are warranted to confirm these findings and guide clinical integration. Characteristics of randomized clinical studies and type of complementary and alternative medicine (CAM) intervention. Sr. No. Author (Year) Country Cancer Type CAM Intervention Comparator Sample Size Outcomes 1 Tröger et al., 2009 Serbia Breast Mistletoe extract Standard care 61 Neutropenia, QoL 2 Tröger et al., 2014 Serbia Breast Helixor A Standard care 65 ANC, QoL 3 Pelzer & Tröger, 2018 Multi-center Breast Mistletoe extracts Standard care 95 Febrile neutropenia 4 Shahriari et al., 2021 Iran Leukemia Chamomile Control 70 ANC, WBC 5 Bar-Sela et al., 2007 Israel Breast Wheat grass juice Standard care 60 Myelotoxicity 6 Araújo et al., 2012 Brazil Mixed Uncaria tomentosa Placebo 40 Immune recovery 7 Pilot RCT Iran Mixed Herbal CAM Standard care 45 Neutropenia duratio