The Role of Antioxidant Supplementation in Patients Undergoing Hematopoietic Stem Cell Transplantation: A Systematic Review Publisher



Heidari S ; Shahrami B ; Rad S ; Biglari M ; Tavajohi R ; Vaezi M
Source: European Journal of Cancer Care Published:2025

Abstract

Background: Patients undergoing hematopoietic stem cell transplantation (HSCT) often face complications during the acute posttransplantation period. HSCT complications are linked to oxidative stress (OS) mechanisms due to accumulation of reactive oxygen species. Researchers hypothesize that antioxidant levels may modify OS immediately after HSCT. Objective: This systematic review aimed to collect evidence on the role of antioxidant supplementation in determining the outcomes and complications of HSCT. Study Design: A systematic search of two databases was conducted, including studies published until January 2024. Inclusion criteria involved clinical original studies focusing on adults and children undergoing HSCT who received antioxidant supplementation during and/or after HSCT. Results: The review included 20 eligible studies, featuring antioxidants such as N-acetyl cysteine, vitamin C, zinc, selenium, vitamin E, and melatonin. Outcomes examined included immune system recovery, engraftment, oral mucositis, liver toxicity, nephrotoxicity, and acute graft-versus-host disease. The findings indicate an unclear association between antioxidant use and complications after HSCT. The certainty of evidence for these outcomes was low or very low. Conclusions: Although the use of antioxidants in HSCT patients has been deemed safe and has even been associated with positive outcomes in some studies, the necessity for antioxidant supplementation during HSCT remains uncertain. Further large randomized controlled trials are necessary to ascertain antioxidant requirements and establish precise supplementation protocols for HSCT patients. © 2025 Elsevier B.V., All rights reserved.