Table 3.

Study adherence to the “gold standard.”

Study		Patient population	Clinical setting	Control and randomization	Blinding and concealment of allocation	End points	Study duration	Presentation and analysis of results	Reporting the trial
Bani Mohammad and Ahmad [35], 2019
	Met criteria	Completely met	Completely met	Completely met	Not completely met	Completely met	Completely met	Completely met	Not completely met
	Description	A total of 80 patients (average age of 52 years) with breast cancer	Medical and surgical wards of a specialized cancer center in Jordan	Random assignment was done based on flipping a coin; if heads appeared, then the first participant was placed in the intervention group. The rest of the participants were placed in the study groups by the order of meeting the eligibility criteria.	N/Aa	The VASb was used to measure pain, and the SAIc was used to measure anxiety.	One session occurred for 20 to 30 minutes; VRd was timed with peak morphine efficacy and the goal was acute pain relief.	There was a statistically significant improvement in pain scores and anxiety levels, and no MCIDe was mentioned.	None mentioned outside of ethics or IRBf approvals from individual hospitals
Burrai et al [36], 2023
	Met criteria	Completely met	Completely met	Completely met	Not completely met	Completely met	Completely met	Completely met	Completely met
	Description	A total of 74 patients (average age of 59 years) with cancer	Regional hospital in Italy	An independent researcher used a random number generation software with simple randomization. A total of 3 numerical codes for the 3 allocation groups were used: 1 for the VR group, 2 for the narrative medicine group, and 3 for the standard care group. To implement the random allocation sequence, sequentially numbered, opaque, sealed envelopes were used.	Owing to the nature of VR and narrative medicine interventions, it was impossible to obtain a blinding between the participants and knowledge of the group, so this study is open-label type.	Anxiety was measured with the STAI-Y1g; fatigue was measured with the revised Piper Fatigue Scale; and pain was measured with the VAS scored from 0 to 10, where 0 indicates no pain and 10 indicates the worst possible pain.	VR was administered just after ATh began and the immersion duration was 30 minutes.	Mean anxiety significantly decreased over time for the VR group and narrative medicine group. There was no significant difference in levels of fatigue, but overall levels of fatigue decreased for participants in the VR intervention. There was no significant difference in pain levels.	The study was registered in the US National Institutes of Health (NCT05629507).
Chatterjee et al [37], 2022
	Met criteria	Completely met	Completely met	Completely met	Not completely met	Completely met	Completely met	Completely met	Completely met
	Description	A total of 40 patients (average age: not provided, median 77.5 years) with unilateral stroke	Stroke unit at the Countess of Chester Hospital NHSi Foundation Trust.	Participants were randomized on a 3:1 allocation basis.	This study was not effective to implement as a double-blind trial, as most patients were able to deduce whether they were a part of the treatment group.	The MoCAjwas the primary measure used and the NEADLk, HADSl, and quality of life (EuroQoLm) were the secondary measures used.	A total of 5 days a week for up to 2 weeks before their hospital discharge time that each patient spent in a VR session was very specific to the individual. Time spent in a session would depend on their level of wellness on the day and how tired they were feeling.	There was a statistically significant improvement in attention and orientation. There were no statistically significant differences in the primary outcome measures at 3 months. Secondary outcomes: there was a statistically significant reduction in anxiety scores in the mild to moderate cognitive impairment (MoCA 15-24) treatment group.	The trial was registered in the ISRCTNn registry (ISRCTN16608742).
Chirico et al [38], 2020
	Met criteria	Completely met	Completely met	Completely met	Not completely met	Completely met	Completely met	Completely met	Not completely met
	Description	A total of 58 patients (average age of 55 years) with breast cancer Tumor stages, n (%): 1: 8 (26.6); 2: 13 (43.3); 3: 9 (30)	National Cancer Institute, IRCCS “Fonda-zione G. Pascale,” Naples, Italy	Patients were randomly assigned to the VR or music therapy group and were compared with a nonconcurrently recruited CGo.	Participants and personnel knew which groups were control and intervention groups.	SAI for adults and SV‐POMSp	Each chemotherapy treatment lasted for 45 to 90 minutes, but the patient used VR for 20 minutes.	There was a statistically significant reduction in anxiety levels between the pretest and posttest and a significant interaction effect between the time factor and the intervention factor (time ×intervention) on the patient’s level of anxiety. Furthermore, the analysis showed a significant main effect for the time factor and significant reduction between the preintervention and the postintervention phases in the following negative mood states: tension, depression, anger, and fatigue.	None mentioned outside of ethics or IRB approvals from individual hospitals.
Groninger et al [39], 2021
	Met criteria	Completely met	Completely met	Completely met	Not completely met	Completely met	Completely met	Completely met	Completely met
	Description	A total of 88 patients (average age of 56 years) with ACC or AHAq stage C or D heart failure	A 912-bed academic hospital located within MWHCr in Washington, DC.	Participants were randomized by the study coordinator on a 1:1 basis using a computerized randomized scheme.	The nature of the study prevented participants and the study coordinator from being blinded to assigned interventions.	Self-reported pain scores and the FACIT-Pal 14s item scale were used.	There was 1 session for 10 minutes. In distraction therapy research, there is currently no predetermined time threshold for the effect on pain experience; 10 minutes falls within the range of time frames (2 to 15 minutes) that have demonstrated the benefit of using VR for pain management.	There was a statistically significant improvement in pain score.	The trial was registered on ClinicalTrials.gov (identifier: NCT04572425).
Hsu et al [40], 2022
	Met criteria	Completely met	Completely met	Completely met	Completely met	Completely met	Completely met	Completely met	Not completely met
	Description	A total of 52 patients (average age of 55 years) with stroke	Department of physical medicine and rehabilitation at a medical center in South Taiwan	Following eligibility screening, patients meeting the inclusion criteria were randomly allocated to conditions using opaque envelopes with computer-generated random numbers that the investigator opened upon receiving a consenting participant.	Eligible patients were randomly allocated until all the available envelopes had been exhausted, resulting in a 1:1:1 ratio in the MTt, COTu, or VR-MT group.	The FMA-UEv motor coordination score and the MALw were used.	The study duration was 30 minutes twice a week for 9 weeks. VR timing was time-matched to the control group.	There was a statistically significant improvement in only the FMA-UE motor coordination and the MAL amount of use; no MCID was mentioned.	None mentioned outside of ethics or IRB approvals from individual hospitals
Huang et al [41], 2022
	Met criteria	Completely met	Completely met	Completely met	Completely met	Completely met	Completely met	Completely met	Completely met
	Description	A total of 30 patients (average age of 58 years) with stroke infarction hemorrhage and ischemic stroke	The VR equipment was installed in a room without external disturbances, and the virtual environment was set in a 6 m2 physical space in a hospital in southern Taiwan.	A total of 30 patients with chronic stroke were randomized to the VR or COT groups	Clinical assessments were performed within 1 week before and after the interventions by another therapist not involved in training and blinded to the purpose and group allocation.	The FMA-UE and AROMx were used.	All participants received 16 sessions of intervention for 60 min per day, 2 to 3 days per week.	There was a statistically significant time effect for all items of upper limb assessment except FMA-UE motor coordination and speed.	The trial was registered in the WHOy International Clinical Trials registry (ChiCTR2100047853).
Huang et al [42], 2024
	Met criteria	Completely met	Completely met	Completely met	Not completely met	Completely met	Completely met	Completely met	Completely met
	Description	A total of 40 patients (average age of 63 years) with ischemic or hemorrhagic stroke	Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, China	Each participant was randomly assigned a code based on computer-generated, permuted block randomization with a block size of 4.	Because of the nature of the intervention, participants and therapists could not be blinded to the allocated treatment. These therapists did not participate in assessments of the outcomes.	The FMA-UE [20] and the BIz were used.	All participants received rehabilitation training for 5 days per week for 3 weeks. The first 30 minutes was conventional rehabilitation, followed by 30 minutes of rehabilitation performed in imVRaa systems	There were statistically significant improvements in FMA-UE motor impairment and BI scores.	The trial was registered on ClinicalTrials.gov (identifier: NCT03086889).
Jo et al [43], 2024
	Met criteria	Completely met	Completely met	Completely met	Completely met	Completely met	Completely met	Completely met	Completely met
	Description	A total of 45 patients (average age of 50 years) with stroke	Hospital in Seoul, Republic of Korea	Randomized controlled trial with the participants randomly allocated into 3 groups using a computer-generated list of numbers at a 1:1:1 ratio: imVR-based 360° MTGab, TMTGac, and a CG	The study was conducted as an assessor-blinded and randomized controlled trial.	FMA-UE was used, and secondary outcome measurements were MFTad and BBTae.	In addition to conventional physical therapy, traditional MT was provided for 30 minutes per session, 3 sessions a week, for 4 weeks	There was a significant improvement in FMA-UE, MFT, and BBT in 360° MTG and TMTG and changes in 360° MTG were significantly higher compared to TMTG and CG.	The trial was registered on ClinicalTrials.gov (NCT05796843) and received approval from the Sahmyook University IRB (SYU 2023-01-009-001)
Laghlam et al [44], 2021
	Met criteria	Completely met	Completely met	Completely met	Completely met	Completely met	Completely met	Completely met	Completely met
	Description	A total of 180 patients (average age of 68 years) with cardiac surgery	ICUaf of the Centre Médico-Chirurgical Ambroise Paré in Neuilly-sur-Seine, France.	Randomization was performed using an external interactive web response system.	Patients were randomly assigned (1:1) in permuted blocks.	The NRSsag for pain and anxiety were used.	One session started at least 5 minutes before the removal of the drains and continued for 10 minutes after the removal of the drains. VR was timed with morphine administration (and the goal was for acute pain relief).	There were no statistically significant improvements in patient functional outcomes; no MCID was mentioned.	The trial was registered on ClinicalTrials.gov (NCT03956264).
Lee and Kang [45], 2020
	Met criteria	Completely met	Completely met	Completely met	Not completely met	Completely met	Did not completely meet	Completely met	Not completely met
	Description	A total of 48 patients (average age of 63 years) with cardiovascular disease	Cardiac ICU, Dong-A University Medical Center, Busan, South Korea.	Patients were randomly allocated with a 1:1 random list order using the random allocation software program (version 2.0.0). ICU nurses did not know which group the next participant would be assigned to.	Double blindness was not possible due to the interventional characteristics of the study using VR equipment.	The PSQIah was used.	The study duration was 30 minutes before bedtime (9 PM to 11 PM) on the day of ICU admission. The difference in sleep quality and the effects of intervention during the ICU stay could not be investigated	There was a statistically significant higher PTSI score in the VR group.	Nothing was mentioned other than the IRB approval.
Mekbib et al [46], 2021
	Met criteria	Completely met	Completely met	Completely met	Completely met	Completely met	Completely met	Completely met	Not completely met
	Description	A total of 23 patients (average age of 56 years) with stroke	Department of Rehabilitation Medicine at Zhejiang Province People’s Hospital (Hangzhou, China).	This clinical trial used a single-blind, randomized, parallel group design. Patients were randomly assigned to either the VR or OTai group using random numbers generated by a computer program.	The group allocation procedure was managed by a physician who was unaware of the study protocol.	The FMA-UE and BI scores were used.	Study duration was 1 hour VR and 1 hour OT per day, 4 days per week for 2 weeks. VR timing was time-matched to the CG.	There was a statistically significant improvement in FMA-UE and BI scores; no MCID was mentioned.	None mentioned outside of ethics or IRB approvals from individual hospitals and the Helsinki Declaration of Ethical Principles for Medical Research Involving Human Subjects
Menekli et al [47], 2022
	Met criteria	Completely met	Completely met	Completely met	Not completely met	Completely met	Not completely met	Completely met	Completely met
	Description	A total of 139 patients (average age: not provided) with cancer	Malatya Turgut Özal University Oncology Hospital	Computer-assisted simple randomization was used to determine the groups.	There was no blinding for the patients or the researchers throughout the study.	The SAI and VAS scores were used.	The study was conducted at the liberty of the patient throughout the procedure, lasting 4 hours.	There was a statistically significant improvement in the SAI and VAS scores; no MCID was mentioned.	The trial was registered on ClinicalTrials.gov (NCT05140707).
Ögün et al [48], 2019
	Met criteria	Completely met	Completely met	Completely met	Completely met	Completely met	Completely met	Completely met	Completely met
	Description	A total of 65 patients (average age of 61 years) with ischemic stroke	Bolu Abant Izzet Baysal University, Physical Therapy and Rehabilitation Hospital	Patients were randomly divided into 2 groups, VR or control, with stratified randomization according to age, sex, and stroke onset, using an online randomization website.	Both patients and outcome assessors were masked, achieved using sham VR therapy with the CG, with the outcome assessor blinded to the groups.	FMA-UE, ARATaj, FIMak, PASS-IADLal, and PASS-BADLam were used as secondary outcome measurements.	The VR group received VR rehabilitation 3 days a week, on Monday, Wednesday, and Friday, at the same time each day for 6 weeks. Each session lasted approximately 60 minutes and comprised 4 games that lasted 15 minutes each.	There was a statistically significant improvement in FMA-UE, ARAT, FIM, and PASS scores.	The trial was registered on ClinicalTrials.gov (NCT03135418).
Park et al [49], 2013
	Met criteria	Completely met	Completely met	Completely met	Not completely met	Completely met	Completely met	Completely met	Not completely met
	Description	A total of 16 patients (average age of 48 years) with stroke	Stroke units of a hospital in Seoul, Korea.	The 16 participants were randomly assigned to either the experimental group (n=8) or the CG (n=8) by selection of white or black go stones 1 hour before the start of the pretest.	N/A	The patient’s spatiotemporal gait ability, functional gait ability, and increased functional walking ability were measured.	The study duration was 60 minutes per day, 5 days per week for 4 weeks. VR timing was time-matched to the CG.	There were no statistically significant improvements in patient functional outcomes; no MCID was mentioned.	None mentioned outside of ethics or IRB approvals from individual hospitals
Rousseaux et al [50], 2022
	Met criteria	Completely met	Completely met	Completely met	Not completely met	Completely met	Not completely met	Completely met	Completely met
	Description	A total of 100 patients (average age of 66 years) who underwent cardiac surgery	Liege University Hospitals, Domaine Universitaire du Sart Tilman	Randomization was undertaken in blocks of 5 patients.	Given the nature of the techniques, neither the patients nor the investigators were blinded to the treatment assignment.	The VAS was used.	The study comprised a 20-minute session on the preoperative day (T0 and T1) and a 20-minute session after surgery (T2 and T3). No justification was written in the manuscript for the study duration.	There was no statistically significant difference in effectiveness between hypnosis and VR	The trial was registered retrospectively on ClinicalTrials.gov (NCT03820700).
Rutkowski et al [51], 2021
	Met criteria	Completely met	Completely met	Completely met	Completely met	Completely met	Completely met	Completely met	Completely met
	Description	A total of 50 patients (average age of 64 years) with COPDan	A specialist Hospital in Głuchołazy, Poland	Randomization was performed using the Research Randomizer (ratio of 1:1), a web-based service that offers instant random assignment. Sealed envelopes were used for group assignments.	An assessor-blinded parallel group	The HADS, PSQao, 6MWTap, and lung function test with FEV1aq were used.	The study was conducted once a day, each session for 15 to 30 minutes (depending on the task), 5 times a week for 2 weeks. VR group performed 10 VR therapy sessions of 20 minutes.	There was statistically significant improvement in the HADS-Aar, HADS-Das, and general HADS.	The trial was registered on ClinicalTrials.gov (NCT0460154).
Shin et al [52], 2023
	Met criteria	Completely met	Completely met	Completely met	Completely met	Completely met	Completely met	Completely met	Completely met
	Description	A total of 196 patients (average age of 47.5 years) with breast cancer	Academic hospital in Seoul, South Korea.	Randomization was done using an online randomizing tool (www.randomizer. org) by an independent research coordinator.	Physicians were blinded to the study arms and did not interact with the coordinator.	Anxiety levels were measured using the APAISat as the primary end point and the STAI and LASAau as secondary end points	The study was for a single time; on the same day of randomization, patients watched the 7- to 8-minute-long VR video.	There was a statistically significant reduction in patient anxiety immediately and on the primary end point, APAIS, and on the STAI and LASA anxiety scales. Long-term anxiety reduction was observed only when anxiety was measured by LASA.	The protocol was registered on ClinicalTrials.gov (NCT04141943) and approved by the Severance Hospital IRB (4-2019-0795).
Song and Lee [53], 2021
	Met criteria	Completely met	Completely met	Completely met	Not completely met	Completely met	Completely met	Completely met	Not completely met
	Description	A total of 10 patients (average age of 64 years) with stroke with chronic hemiplegia	C Rehabilitation Hospital or G Rehabilitation Hospital in Gwangju city	Randomization was achieved using the opaque sealed envelope method.	N/A	Manual function test and proprioception test	Interventions were performed for 30 minutes a day, 5 times a week, for 4 weeks, for 20 sessions.	There was a statistically significant improvement in the proprioception test.	None mentioned outside of ethics or IRB approvals from individual hospitals
Spiegel et al [54], 2019
	Met criteria	Completely met	Completely met	Completely met	Completely met	Completely met	Completely met	Completely met	Completely met
	Description	A total of 120 patients (average age: not provided) with pain	Cedars-Sinai Medical Center, a large, urban, tertiary care hospital	Patients were randomized on a 1:1 basis between groups using the Microsoft Excel random number generator.	A script that used neutral language regarding both interventions was used. Investigator interactions with the study participant were minimized, relying on nonstudy nursing staff to collect pain scores.	An NRS of patient-reported pain was used.	The study duration was 10 minutes per session, 3 times a day, for 48 hours; 10 minutes was selected to reduce the risk of developing cybersickness. Longer exposure times are associated with a higher risk of cybersickness.	There was a statistically significant improvement in pain scores 48 hours and 72 hours postintervention.	The trial was registered on ClincialTrials.gov (NCT02887989).
Torres García et al [55], 2023
	Met criteria	Completely met	Completely met	Completely met	Not completely met	Completely met	Completely met	Completely met	Completely met
	Description	A total of 133 patients (average age of 49 years) with breast cancer	OCCUav of the CIMAaw Campus, Milenium Iradier Medical Center, Barcelona, Spain	Randomization was carried out using a random number list obtained with the Random.org app. The order in which it was generated was unknown to the oncologist.	The oncologist was unaware of the information provided other than the order in which randomization was generated.	HADS, DDEax scale, and the Mini-MACay coping scale were used.	The study comprised 4 sessions lasting approximately 30 to 45 minutes. The first 3 sessions coincided with the chemotherapy treatment prescribed by the oncologist. The fourth session was conducted 3 months after the third session to check whether the benefits of the previous interventions were maintained.	There was a statistically significant reduction in anxiety and depression and significant improvements in emotional distress and coping mechanisms, including fighting spirit, cognitive avoidance, and anxious worry.	The study was approved by the Clinical Research Ethics Committee (CEIC) of Hospital CIMA (Barcelona, Spain), a center authorized by the Department of Health (H08621946).
Turrado et al [56], 2021
	Met criteria	Completely met	Completely met	Completely met	Not completely met	Completely met	Completely met	Completely met	Completely met
	Description	A total of 126 patients (average age of 66 years) with the following condition, n (%): colorectal cancer: 58 (46); right colectomy: 21 (16.7); sigmoidectomy: 20 (15.9); LARaz+TaTMEba: 25 (19.8); transverse colon resection: 2 (1.6)	Third-level Academic Center in the Gastrointestinal Surgery Department in Barcelona, Spain	Patients were randomized using en bloc randomization with random block sizes.	Patients and health care professionals could not be blinded regarding group assignment.	HAD-D, HAD-A, STAI_A/S, and STAI_A/T scores were used.	The patients in the intervention group had unlimited access to VR glasses and to the VR app.	There was a statistically significant improvement for both the HADS-A and HADS-D subscales and those measuring status and trait in STAI scales in patients who were exposed to the VR simulation experience.	The trial was registered on ClinicalTrials.gov (NCT04058600).
Uslu and Arslan [57], 2023
	Met criteria	Completely met	Completely met	Completely met	Not completely met	Completely met	Completely met	Completely met	Completely met
	Description	A total of 66 patients (average age of 52 years) with breast cancer	Oncology outpatient department of a university hospital in Turkey	This study was conducted using the randomization block method (6:5). Combinations with randomization were enumerated using a web-based random queue generator with permuted random block allocation (block size: 33). The intervention group and CG were determined by lots.	Blinding was not possible due to the nature of the study. With VR, the patients could not be blinded during the intervention because they knew that they were in the intervention group. Randomization was prepared by a statistician, but this was hidden from the researcher performing the study.	The STAI scale and the CFSbb were used.	The study was conducted once every 21 days for 4 sessions (1 session per chemotherapy cycle for 4 cycles) for 30 minutes.	There was a statistically significant decrease in mean postintervention anxiety scores and mean posttest fatigue.	The trial was registered with the US National Institutes of Health Clinical Trials Registry on September 12, 2021 (NCT05168696)
Zhang et al [58], 2023
	Met criteria	Completely met	Completely met	Completely met	Not completely met	Completely met	Completely met	Completely met	Completely met
	Description	A total of 60 patients (average age of 34 years) with leukemia	A public hospital in Guangzhou, China	Participants were randomly assigned to the intervention group and CG in a 1:1 ratio by generating 70 codes written on identically sized pieces of paper, which were placed in opaque, sealed, and sequentially numbered envelopes.	Owing to the nature of VR intervention, blinding the participants and the interventionist was impossible.	The SAI scale, CES-Dbc scale, and FACT-leubd questionnaire were used.	From days 1 to 14, participants experienced 14 different immersive videos. To avoid interruption from common treatment activities, every intervention occurred from 3 PM to 6 PM.	Those in the intervention group demonstrated a significantly greater reduction in anxiety (P<.05) and improvement in quality of life (P=.04). There was no significant difference in depression levels between groups (P=.09), although a decreasing trend was observed in the intervention group.	The protocol was registered retrospectively in the ISRCTN registry (ISRCTN 84842464; June 6, 2022).

^aN/A: not applicable.

^bVAS: Visual Analog Scale.

^cSAI: State Anxiety Inventory.

^dVR: virtual reality.

^eMCID: minimal clinically important difference.

^fIRB: institutional review board.

^gSTAI-Y1: State-Trait Anxiety Inventory-Y1.

^hAT: antiblastic therapy.

ⁱNHS: National Health Service.

^jMoCA: Montreal Cognitive Assessment.

^kNEADL: Nottingham extended activities of daily living.

^lHADS: Hospital Anxiety and Depression Scale.

^mEuroQOL: European Quality of Life.

ⁿISRCTN: International Standard Randomized Controlled Trial Number.

^oCG: control group.

^pSV-POMS: short version of profile of mood states.

^qAHA or ACC: American Heart Association or American College of Cardiology.

^rMWHC: MedStar Washington Hospital Center.

^sFACIT-Pal 14: Functional Assessment in Chronic Illness Therapy–Palliative Care 14-item scale.

^tMT: mirror therapy.

^uCOT: conventional occupational therapy.

^vFMA-UE: Fugl-Meyer assessment for upper extremity.

^wMAL: motor activity log.

^xAROM: active range of motion.

^yWHO: World Health Organization.

^zBI: Barthel Index.

^aaimVR: immersive virtual reality.

^ab360° MTG: 360° mirror therapy group.

^acTMTG: traditional mirror therapy group.

^adMFT: manual function test.

^aeBBT: box and block test.

^afICU: intensive care unit.

^agNRS: numeric rating scale.

^ahPSQI: Pittsburg Sleep Quality Index.

^aiOT: occupational therapy.

^ajARAT: action research arm test.

^akFIM: functional independence measure.

^alPASS-IADL: performance assessment of self-care skills—instrumental activities of daily living.

^amPASS-BADL: performance assessment of self-care skills—basic activities of daily living.

^anCOPD: chronic obstructive pulmonary disease.

^aoPSQ: Perception of Stress Questionnaire.

^ap6MWT: 6-minute walk test.

^aqFEV1: forced expiratory volume for 1 second.

^arHADS-A: Hospital Anxiety and Depression Scale-Anxiety.

^asHADS-D: Hospital Anxiety and Depression Scale-Depression.

^atAPAIS: Amsterdam Preoperative Anxiety and Information Scale.

^auLASA: Linear Analog Scale Assessment.

^avOCCU: Oncology Counseling and Care unit.

^awCIMA: Chartered Institute of Management Accountants.

^axDDE: emotional discomfort detection.

^ayMini-MAC: mini-mental adjustment to cancer.

^azLAR: low anterior resection.

^baTaTME: transanal total mesorectal resection.

^bbCFS: Cancer Fatigue Scale.

^bcCES-D: Center for Epidemiological Studies-Depression Scale.

^bdFACT-leu: functional assessment of cancer therapy-leukemia.