Can probiotics reduce chemotherapy‐induced complications in leukemia patients? A systematic review and meta‐analysis of randomized controlled trials

This meta‐analysis aimed to evaluate the effectiveness and reliability of probiotic interventions in managing chemotherapy‐induced complications among patients with leukemia, providing evidence‐based insights for clinical decision‐making. Studies in PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, and Wanfang Data were comprehensively searched up to March 5, 2024. Randomized controlled trials (RCTs) comparing probiotic use with conventional care in leukemia patients undergoing chemotherapy were included. The included studies examined all possible chemotherapy‐related adverse effects without selective outcome reporting. Data synthesis was conducted using RevMan 5.4 and STATA 15.0. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach was used to evaluate the quality of evidence for each outcome. Eight RCTs encompassing 753 participants were analyzed. Compared with conventional care, probiotics significantly reduced constipation (odds ratio [OR] = 0.61, 95% CI = 0.30–1.24, P < 0.05), nausea (OR = 0.51, 95% CI = 0.41–0.63], P < 0.00001), chemotherapy‐induced diarrhea (OR = 0.39, 95% CI = 0.26–0.57], P < 0.00001), bloating (OR = 0.38, 95% CI = 0.20–0.76, P = 0.006), vomiting (OR = 0.62, 95% CI = 0.39–0.98, P = 0.04), and indigestion (OR = 0.55, 95% CI = 0.31–0.95, P = 0.03). Notable improvements were observed in procalcitonin and tumor necrosis factor–alpha levels. Evidence quality was high for most outcomes, with moderate ratings for dyspepsia, constipation, and vomiting. In conclusion, probiotic supplementation appears to moderately alleviate chemotherapy‐induced complications in patients with leukemia. Nevertheless, because of limitations such as small sample sizes and potential data variability, further validation through large‐scale RCTs is necessary.