Supportive Care in Cancer

, Volume 26, Issue 2, pp 657–665 | Cite as

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

  • Gary DengEmail author
  • Sergio Giralt
  • David J. Chung
  • Heather Landau
  • Jonathan Siman
  • Benjamin Search
  • Marci Coleton
  • Emily Vertosick
  • Nathan Shapiro
  • Christine Chien
  • Xin S. Wang
  • Barrie Cassileth
  • Jun J. Mao
Original Article



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.


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.


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).


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



Acupuncture Multiple myeloma Hematopoietic stem cell transplantation Symptom management Complementary therapies Integrative medicine 


Authors’ contributions

We would like to thank Yi Chan, Matthew Weitzman, Theresa Affuso (acupuncturists); Khaula Malik, Kelsi Clement, Jeremy Taylor, Mollie McMahon, Janice DeRito (research study assistants); and Andrew Vickers, PhD (biostatistician) for their work in this study, which was supported by funding from the NIH/NCI Cancer Center Support Grant P30 CA008748. In addition, we thank IH and CS for their help in the preparation and submission of this manuscript, which was also supported by funding from NIH/NCI Cancer Center Support Grant P30 CA008748.


The study was funded by a grant from the Gateway for Cancer Research, and the MSK Integrative Medicine and Translational Research Grant. We also received support from the National Institutes of Health/National Cancer Institute (NIH/NCI) Cancer Center Support Grant P30 CA008748, the AC Israel Foundation, and the Byrne Fund.

Compliance with ethical standards

This study was approved by the Institutional Review Board (IRB) at Memorial Sloan Kettering Cancer Center. All procedures performed were in accordance with the ethical standards of the institutional research committee.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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.

Role of the funder/sponsor

The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Supplementary material

520_2017_3881_MOESM1_ESM.docx (20 kb)
ESM 1 (DOCX 20 kb)


  1. 1.
    Copelan EA (2006) Hematopoietic stem-cell transplantation. N Engl J Med 354(17):1813–1826. CrossRefPubMedGoogle Scholar
  2. 2.
    Gertz MA, Dingli D (2014) How we manage autologous stem cell transplantation for patients with multiple myeloma. Blood 124(6):882–890. CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Giralt S (2011) Stem cell transplantation for multiple myeloma: current and future status. Hematol Am Soc Hematol Educ Program 2011:191–196. Google Scholar
  4. 4.
    Anderson KO, Giralt SA, Mendoza TR, Brown JO, Neumann JL, Mobley GM, Wang XS, Cleeland CS (2007) Symptom burden in patients undergoing autologous stem-cell transplantation. Bone Marrow Transplant 39(12):759–766. CrossRefPubMedGoogle Scholar
  5. 5.
    Campagnaro E, Saliba R, Giralt S, Roden L, Mendoza F, Aleman A, Cleeland C, Weber D, Brown J, Anderson KO (2008) Symptom burden after autologous stem cell transplantation for multiple myeloma. Cancer 112(7):1617–1624. CrossRefPubMedGoogle Scholar
  6. 6.
    Mosher CE, Redd WH, Rini CM, Burkhalter JE, DuHamel KN (2009) Physical, psychological, and social sequelae following hematopoietic stem cell transplantation: a review of the literature. Psycho Oncology 18(2):113–127. CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Ramsenthaler C, Osborne TR, Gao W, Siegert RJ, Edmonds PM, Schey SA, Higginson IJ (2016) The impact of disease-related symptoms and palliative care concerns on health-related quality of life in multiple myeloma: a multi-centre study. BMC Cancer 16:427. CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Wang XS, Shi Q, Shah ND, Heijnen CJ, Cohen EN, Reuben JM, Orlowski RZ, Qazilbash MH, Johnson VE, Williams LA, Mendoza TR, Cleeland CS (2014) Inflammatory markers and development of symptom burden in patients with multiple myeloma during autologous stem cell transplantation. Clin Cancer Res 20(5):1366–1374. CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Cohen MZ, Rozmus CL, Mendoza TR, Padhye NS, Neumann J, Gning I, Aleman A, Giralt S, Cleeland CS (2012) Symptoms and quality of life in diverse patients undergoing hematopoietic stem cell transplantation. J Pain Symptom Manag 44(2):168–180. CrossRefGoogle Scholar
  10. 10.
    Kaptchuk TJ (2002) Acupuncture: theory, efficacy, and practice. Ann Intern Med 136(5):374–383CrossRefPubMedGoogle Scholar
  11. 11.
    Huang W, Pach D, Napadow V, Park K, Long X, Neumann J, Maeda Y, Nierhaus T, Liang F, Witt CM (2012) Characterizing acupuncture stimuli using brain imaging with FMRI: a systematic review and meta-analysis of the literature. PLoS One 7(4):e32960. CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Stone JA, Johnstone PA (2010) Mechanisms of action for acupuncture in the oncology setting. Curr Treat Options in Oncol 11(3–4):118–127. CrossRefGoogle Scholar
  13. 13.
    Han JS (2011) Acupuncture analgesia: areas of consensus and controversy. Pain 152(3 Suppl):S41–S48. CrossRefPubMedGoogle Scholar
  14. 14.
    Pyne D, Shenker NG (2008) Demystifying acupuncture. Rheumatology (Oxford) 47(8):1132–1136. CrossRefGoogle Scholar
  15. 15.
    Ezzo JM, Richardson MA, Vickers A, Allen C, Dibble SL, Issell BF, Lao L, Pearl M, Ramirez G, Roscoe J, Shen J, Shivnan JC, Streitberger K, Treish I, Zhang G (2006) Acupuncture-point stimulation for chemotherapy-induced nausea or vomiting. Cochrane Database Syst Rev 2:CD002285. Google Scholar
  16. 16.
    Shen J, Wenger N, Glaspy J, Hays RD, Albert PS, Choi C, Shekelle PG (2000) Electroacupuncture for control of myeloablative chemotherapy-induced emesis: a randomized controlled trial. JAMA 284(21):2755–2761CrossRefPubMedGoogle Scholar
  17. 17.
    Rithirangsriroj K, Manchana T, Akkayagorn L (2015) Efficacy of acupuncture in prevention of delayed chemotherapy induced nausea and vomiting in gynecologic cancer patients. Gynecol Oncol 136(1):82–86. CrossRefPubMedGoogle Scholar
  18. 18.
    Greenlee H, Balneaves LG, Carlson LE, Cohen M, Deng G, Hershman D, Mumber M, Perlmutter J, Seely D, Sen A, Zick SM, Tripathy D, Society for Integrative O (2014) Clinical practice guidelines on the use of integrative therapies as supportive care in patients treated for breast cancer. J Natl Cancer Inst Monogr 2014(50):346–358. CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Vickers AJ, Cronin AM, Maschino AC, Lewith G, MacPherson H, Foster NE, Sherman KJ, Witt CM, Linde K, Acupuncture Trialists C (2012) Acupuncture for chronic pain: individual patient data meta-analysis. Arch Intern Med 172(19):1444–1453. CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Lau CH, Wu X, Chung VC, Liu X, Hui EP, Cramer H, Lauche R, Wong SY, Lau AY, Sit RS, Ziea ET, Ng BF, Wu JC (2016) Acupuncture and related therapies for symptom management in palliative cancer care: systematic review and meta-analysis. Medicine (Baltimore) 95(9):e2901. CrossRefGoogle Scholar
  21. 21.
    Garcia MK, Graham-Getty L, Haddad R, Li Y, McQuade J, Lee RT, Spano M, Cohen L (2015) Systematic review of acupuncture to control hot flashes in cancer patients. Cancer 121(22):3948–3958. CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Hackett KL, Deane KH, Strassheim V, Deary V, Rapley T, Newton JL, Ng WF (2015) A systematic review of non-pharmacological interventions for primary Sjogren's syndrome. Rheumatology (Oxford) 54(11):2025–2032. CrossRefGoogle Scholar
  23. 23.
    Mao JJ, Farrar JT, Bruner D, Zee J, Bowman M, Seluzicki C, DeMichele A, Xie SX (2014) Electroacupuncture for fatigue, sleep, and psychological distress in breast cancer patients with aromatase inhibitor-related arthralgia: a randomized trial. Cancer 120(23):3744–3751. CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Lao L, Bergman S, Hamilton GR, Langenberg P, Berman B (1999) Evaluation of acupuncture for pain control after oral surgery: a placebo-controlled trial. Arch Otolaryngol Head Neck Surg 125(5):567–572CrossRefPubMedGoogle Scholar
  25. 25.
    Lao L, Bergman S, Langenberg P, Wong RH, Berman B (1995) Efficacy of Chinese acupuncture on postoperative oral surgery pain. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 79(4):423–428CrossRefPubMedGoogle Scholar
  26. 26.
    Cleeland CS, Mendoza TR, Wang XS, Chou C, Harle MT, Morrissey M, Engstrom MC (2000) Assessing symptom distress in cancer patients: the M.D. Anderson Symptom Inventory. Cancer 89(7):1634–1646CrossRefPubMedGoogle Scholar
  27. 27.
    Jones D, Vichaya EG, Wang XS, Williams LA, Shah ND, Thomas SK, Johnson VE, Champlin RE, Cleeland CS, Mendoza TR (2013) Validation of the M. D. Anderson Symptom Inventory multiple myeloma module. J Hematol Oncol 6:13. CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    El-Jawahri A, LeBlanc T, VanDusen H, Traeger L, Greer JA, Pirl WF, Jackson VA, Telles J, Rhodes A, Spitzer TR, McAfee S, Chen YA, Lee SS, Temel JS (2016) Effect of inpatient palliative care on quality of life 2 weeks after hematopoietic stem cell transplantation: a randomized clinical trial. JAMA 316(20):2094–2103. CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Gary Deng
    • 1
    Email author
  • Sergio Giralt
    • 2
  • David J. Chung
    • 2
  • Heather Landau
    • 2
  • Jonathan Siman
    • 1
  • Benjamin Search
    • 1
  • Marci Coleton
    • 1
  • Emily Vertosick
    • 3
  • Nathan Shapiro
    • 3
  • Christine Chien
    • 3
  • Xin S. Wang
    • 4
  • Barrie Cassileth
    • 1
  • Jun J. Mao
    • 1
  1. 1.Integrative Medicine Service, Memorial Sloan Kettering Cancer CenterNew YorkUSA
  2. 2.Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer CenterNew YorkUSA
  3. 3.Health Outcomes Research Group, Memorial Sloan Kettering Cancer CenterNew YorkUSA
  4. 4.Department of Symptom ResearchThe University of Texas MD Anderson Cancer CenterHoustonUSA

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