Supportive care interventions in hematopoietic stem cell transplantation: a systematic review and meta-analysis

There is no comprehensive synthesis of supportive care interventions for patients with hematologic malignancies receiving transplantation and cellular therapies (TCTs). This systematic review and meta-analysis aimed to characterize randomized controlled trials (RCTs) of TCT supportive care interventions and examine effects on patient-reported outcomes (PROs). We systematically searched MEDLINE, Embase, CINAHL, PsycInfo, Web of Science, and Cochrane Central Register of Controlled Trials. Risk of bias was assessed using Cochrane Risk of Bias 2.0. Findings were grouped by intervention and PRO type and synthesized narratively, with exploratory random-effects meta-analyses estimating pooled intervention effects on anxiety, depression, and quality of life (QOL). Fifty-three RCTs (1992-2025) met inclusion criteria. The search yielded only RCTs of hematopoietic stem cell transplantation (HSCT) recipients, although we included all transplantation and cellular therapies. Studies varied in sample size (11-711), participant demographics (mean age, 33-63 years; 22%-64% women), and PROs. There were 9 intervention categories: cognitive behavioral (n = 5), exercise only (n = 17), expressive helping (n = 2), mind-body/stress management (n = 7), multimodal (exercise plus another modality; n = 6), music/art (n = 12), palliative care (n = 2), positive psychology (n = 1), and self-management/self-efficacy (n = 5). Interventions were mostly feasible and acceptable, with promising improvements in psychological distress, QOL, and physical outcomes. Meta-analysis showed nonsignificant trends toward exercise interventions improving QOL (standardized mean differences [SMD], 0.09) and music/art interventions reducing acute depressive symptoms (SMD, -0.26). Among patients undergoing HSCT for hematologic malignancies, supportive care interventions show feasibility, acceptability, and promise for improving PROs. However, larger, rigorously designed RCTs using standardized PRO measures are needed to establish efficacy.