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Protective Role of Silymarin in Early Doxorubicin-induced Cardiac Dysfunction in Children with Acute Lymphoblastic Leukemia

[ Vol. 19 , Issue. 2 ]


Adel A. Hagag*, Walid A. El Shehaby, Aml I. El-Abasy and Maaly M. Mabrouk   Pages 133 - 140 ( 8 )


Background: Doxorubicin is a well-established chemotherapeutic agent for the treatment of childhood acute lymphoblastic leukemia (ALL), but its efficacy is often limited by its related cardiotoxicity. Protection against doxorubicin-induced cardiotoxicity can be of great value, especially for children. Silymarin has a potent antioxidant property that can be helpful in preventing cardio-toxicity.

Objective: ‘To assess the possible protective role of silymarin against early doxorubicin-induced cardiotoxicity in children with ALL’.

Subjects and Methods: This study was conducted on 80 children with ALL, including 40 patients under doxorubicin therapy and silymarin 420 mg/day for one week after each doxorubicin dose starting from the day of doxorubicin infusion (Group I) and 40 patients under doxorubicin therapy and placebo (Group II). ‘Conventional echo-Doppler measures of left ventricular systolic and diastolic functions and pulsed wave tissue Doppler of lateral mitral annulus were done for all patients’.

Results: After doxorubicin therapy, there was a significant higher reduction of systolic function [ejection fraction (EF), fraction shortening (FS) and s wave] in Group II compared with Group I and non-significant reduction of diastolic function [E/A ratio or e/a ratio] in both Groups. Although serum troponin increases in both groups after doxorubicin therapy, the increase of troponin is significantly lower in group I compared with group II.

Conclusion: Silymarin decreased early Doxorubicin-induced left ventricular systolic function disturbances and can be recommended as an adjuvant drug in patients with ALL under doxorubicin therapy.

Recommendation: ‘Multicenter studies on a large number of patients with longer follow up’ periods to prove the protective role of silymarin in early and late Doxorubicin-induced cardiotoxicity.


Silymarin, doxorubicin, cardiotoxicity, leukemia, lymphoblastic, children.


Pediatric Department, Faculty of Medicine, Tanta University, Tanta, Pediatric Department, Faculty of Medicine, Tanta University, Tanta, Pediatric Department, Faculty of Medicine, Tanta University, Tanta, Clinical Pathology, Faculty of Medicine, Tanta University, Tanta

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