Evaluating Protective Effects of Silymarin on Liver and Cardiac Side Effects of Chemotherapy Drugs in Childhood Acute Lymphoblastic Leukemia

Abstract

Background: The protective effects of silymarin on liver and heart have been investigated and identified by many researchers. This study evaluates the protective effects of this substance on hepatotoxicity and cardiotoxcity of chemotherapy drugs in leukemic children. Materials and Methods: In this study, 71 children, aging 2-14 years old, going through the maintenance phase of acute lymphoblastic leukemia (ALL) treatment at Children's Cancer Center of Isfahan University of Medical Sciences (Iran) in 2015 were studied. Two patients died and the remaining patients were divided into intervention and control groups. Intervention group received Mercaptopurin and Methotrexate plus Silymarin 140mg/day and control group were taking only Mercaptopurin and Methotrexate. Liver enzymes, Coagulation tests, Creatine kinase-Muscle and Brain (CK-MB), Ejection fraction and Systolic function (SF) were measured at the first, and 3 and 6 months' intervals from the commencement of study. The Data was analyzed by using SPSS and P <= 0.05 was considered as statistically significant. Associations between variables were analyzed using independent t-test, chi square, and repeated measures ANOVA test. Results: Mean levels of Alanine aminotransferase in both groups increased significantly at 6 months interval (P=0.01, 0.01, for control and intervention groups respectively). Although increment was more among controls, there were no significant differences between the two groups (P= 0.85). Furthermore, Aspartate aminotransferase and Alkaline phosphatase increased in both groups and the increment was significant in the controls (P=0.001, 0.05, for control and intervention groups respectively). Coagulation tests prolonged in the first 3 months in both groups and the prolongation was more in control group. Changes in CK-MB were not significant in intervention and controls (P=0.07, 0.10, respectively) but ejection fraction and SF decreased in both groups, especially among controls. Conclusion: It seems that Silymarin can be useful in prevention of hepatotoxicity and cardiotoxcity of chemotherapy drugs for ALL children.