the protective role of deferoxamine in the prevention of doxorubicin-induced hepatic fibrosis in children: a randomized controlled clinical trial

Background: this study aimed to investigate the protective role of deferoxamine (dfo) in the prevention of doxorubicin (dox)-induced hepatic fibrosis in children.methods: in this prospective randomized controlled trial, 61 treatment-naïve children (2-18 years) with different types of cancer who referred to a tertiary teaching hospital in the south of iran were enrolled. they were randomly assigned to 3 groups; group 1 (control, n=21), group 2 (dfo 10 times dox dose, n=20), group 3 (dfo 50mg/kg, n=20). dfo was administered as an 8-hour continuous intravenous infusion during and after dox infusion in each chemotherapy cycle. non-invasive serum markers of liver fibrosis, including ast-to-platelet ratio index (apri), fibrosis-4 (fib-4) score and fibro test were measured in each individual. besides, hepatic fibro scan was used after the last course of chemotherapy to estimate the fibrosis degree.results: alanine aminotransferase was mildly increased after treatment compared to before treatment. the treatment with dfo 10 times dox dose was associated with a significant decline in post-treatment apri (adjusted odds ratio 0.17; 95% confidence interval 0.03- 0.84. p-value=0.015). the metavir fibro scores were in the f0-f1 zone in all participants, and the results were comparable in study groups. no adverse drug effects were reported in the treatment groups.conclusion: dox may not lead to severe liver fibrosis if the maximum cumulative dose allowed is not exceeded. dfo at the dose of 10 times of dox dose may have a potential protective role against liver fibrosis. more studies with longer follow-up are needed to further assess this issue.