Traditional Chinese medicine in febrile neutropenia treatment: advances and prospects

Febrile neutropenia (FN) is a serious chemotherapy complication defined by fever (≥38.3°C) and low neutrophil count (<0.5×10⁹/L). It affects 7–8 per 1,000 cancer patients, with 9.5% mortality. FN often leads to chemotherapy delays, compromising treatment efficacy. Current standard care—antibiotics and granulocyte colony-stimulating factor (G-CSF)—faces limitations including antibiotic resistance, G-CSF side effects (bone pain, vasculitis), and refractory cases. Traditional Chinese medicine (TCM) offers a promising adjunctive approach.

Theoretical Basis
FN corresponds to "fatigue" and "fever" in TCM, first described in Huang Di Nei Jing. Pathogenesis involves qi and blood deficiency from drug toxicity, infections, emotional stress, or improper diet. Key treatment principles include tonifying qi and blood, warming yang, and strengthening the spleen and kidney. TCM's holistic concept treats the whole body, while dialectical treatment provides personalized interventions based on individual patterns.

Clinical Evidence
Combining TCM with standard therapy significantly improves FN outcomes:

• A randomized trial showed adding a "benefiting qi and nourishing yin" formula reduced fever duration by 52 hours and advanced neutrophil recovery by 4 days.

• A large retrospective study (792 patients) found TCM before chemotherapy reduced FN incidence from 71% to 43%.

• A case report showed TCM resolved G-CSF-insensitive FN persisting for two months.

TCM also alleviates other chemotherapy toxicities: reducing blood cell deficiencies, relieving gastrointestinal symptoms, and protecting against neuropathy and cardiotoxicity.

Safety
TCM has a good safety profile with mild, transient side effects. Unlike G-CSF, it does not cause bone pain or increase secondary tumor risk.

Challenges and Prospects
Challenges include unstandardized diagnostic criteria, variable study quality, limited mechanistic research, and unclear optimal timing for TCM intervention. Future directions require multicenter trials, unified treatment standards, and modern pharmacological studies to elucidate mechanisms.

Conclusions
TCM is a promising, safe complementary therapy for FN that enhances standard treatment outcomes. However, high-quality randomized trials are needed to confirm these benefits and establish evidence-based protocols.

Full text:

https://www.xiahepublishing.com/2835-6357/FIM-2025-00035

The study was recently published in the Future Integrative Medicine.

Future Integrative Medicine (FIM) is the official scientific journal of the Capital Medical University. It is a prominent new journal that promotes future innovation in medicine.It publishes both basic and clinical research, including but not limited to randomized controlled trials, intervention studies, cohort studies, observational studies, qualitative and mixed method studies, animal studies, and systematic reviews.

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