Some Tips on Using TCM to Manage Myelosuppression During Radiotherapy and Chemotherapy

The most frequent problem cancer patients face during radiotherapy and chemotherapy is myelosuppression. Both radiation and most chemotherapeutic drugs have myelosuppression as a side effect. So what does human bone marrow do, and what is myelosuppression?

Bone marrow is the birthplace of all blood cells (red cells, white cells, platelets, lymphocytes) and the site where B cells develop and mature in humans and other mammals. So when a treatment has the side effect of myelosuppression, it means the production and development of our blood cells will be affected.

Human hematopoietic stem cells (HSCs) first appear in the yolk sac around 2–3 weeks of embryonic life. During weeks 3–7, HSCs migrate from the yolk sac to the fetal liver, then to the spleen; the liver and spleen become the main hematopoietic organs at this stage. Later, HSCs migrate to the bone marrow, which then becomes the hematopoietic organ for late gestation and after birth.

Within the bone marrow's hematopoietic-inductive microenvironment, HSCs first differentiate into committed stem cells: myeloid stem cells and lymphoid stem cells. The myeloid line further differentiates into granulocytes, monocytes, red cells, and platelets; granulocytes further differentiate into neutrophils, eosinophils, and basophils; monocytes that migrate out of vessels become macrophages distributed throughout the body. The lymphoid line further differentiates into B lymphocytes, T lymphocytes, NK cells, dendritic cells, and other immune cells.

When red cells drop, the patient becomes anemic; when white cells and lymphocytes drop, immunity falls. Myelosuppression therefore not only causes anemia but also lowers the patient's own immunity, making them more susceptible to infection by various pathogens. NK (natural killer) cells are the body's built-in anticancer helpers that clear abnormal cells, including cancer cells; a drop in NK cells weakens our intrinsic antitumor defense.

Cancer patients undergoing chemoradiation must therefore pay close attention to myelosuppression. Easing it can markedly improve the anticancer effect of treatment.

TCM has a proven record of benefit for chemoradiation-induced myelosuppression, validated by numerous clinical cases. To abandon this important adjunct because of prejudice against Chinese medicine would be a pity.

In my experience, TCM formulas that fortify the spleen and kidney, fill essence and marrow, and tonify qi and blood generally improve blood counts and immunity — examples include Shiquan Dabu Wan (Ten-Ingredient Great-Tonifying Pill), Bazhen Tang (Eight-Treasures Decoction), Sizhen Tang (Four-Precious Decoction), and Sijunzi Tang (Four-Gentlemen Decoction).

Note, however, that during chemoradiation, herbs toxic to the liver and kidney should be avoided. These include aconite-type herbs (Fuzi, Chuanwu, Caowu), aristolochia-type herbs (Guanmutong, Mufangji, Madouling, Xixin, and others), as well as Maqianzi (Strychni Semen) and Mubiezi (Momordicae Semen). If the hepatic and renal injury of chemoradiation is superimposed on the nephro- and hepatotoxicity of such herbs, drug-induced liver and kidney damage becomes very likely. Patients choosing Chinese patent medicines or herbal decoctions should first check whether they contain such toxic components.

Ideally, one would address both the cancer and the myelosuppression at once by choosing herbs or formulas that act on both. For example, Kushen (Sophorae Flavescentis Radix), which suppresses ascites and hepatitis B virus while raising white-cell counts, is especially suitable for patients with both HBV and ascitic cancer. Sheng Huangqi (raw Astragali Radix), which raises hemoglobin while promoting diuresis and reducing edema, is especially suitable for cancer patients with both low hemoglobin and edema. Such herbs are too numerous to list in one article; specific clinical problems require the physician to read widely and think creatively during practice to find elegant solutions.

Some TCM physicians reject Western theory and refuse integrated thinking. I personally do not. In practice I often use Western laboratory results to observe the efficacy of Chinese medicine, accumulating data; this has proven very helpful in raising treatment response rates.