Mousa HFM, Abd-El-Fatah NK, Darwish OAH, Shehata SF, Fadel SH. Effect of Nigella sativa seed administration on prevention of febrile neutropenia during chemotherapy among children with brain tumors. Childs Nerv Syst. 2017;33(5):793-800.

The most common solid tumors diagnosed in children are those of the central nervous system. Severe myelosuppression is associated with the combination chemotherapy used to treat such tumors and can lead to the potentially fatal complication febrile neutropenia (FN) ― fever and an abnormally low number of white blood cells. The emergence of multidrug-resistant bacteria caused by the widespread use of antibiotics can lead to worse outcomes in children with cancer who develop FN. Black cumin (Nigella sativa, Ranunculaceae) has been reported to possess antimicrobial and antifungal effects. These authors conducted a randomized, pretest/post-test, controlled trial to investigate the effect of black cumin seed supplementation on the development of FN, the subsequent number of hospital admissions, and hospital length of stay (LOS) in children with brain tumors who were undergoing chemotherapy.

Conducted in the pediatric oncology unit of the main university hospital at Alexandria University in Alexandria, Egypt, the study included 80 patients aged 2 to 18 years with primary brain tumors and undergoing appropriate doses of equivalent chemotherapy protocols. The types of tumors and numbers of patients with those tumors were as follows: medulloblastoma (32), primitive neuroectodermal tumors (11), low-grade glioma (25), atypical teratoid rhabdoid tumors (5), ependymoma (4), choroid plexus carcinoma (2), and mixed germ cell tumor (1). The patients were randomly assigned to either the black cumin group or the control group, with 40 in each group.

During the first phase of the study, anthropometric measurements were recorded, as well as sociodemographic and medical data, and each patient's food consumption patterns. At baseline, patients in both groups had similar anthropometric and socioeconomic backgrounds, though a statistically significant difference between groups for jobs of fathers of children was found (P = 0.022). During the second phase, the parents of the patients in the black cumin group were given a sealed pack of enough whole black cumin seeds for 14 doses of 5 g daily, instructions on how to use them, and a sheet to record each dose taken. Throughout each patient's treatment, the parents were given a new pack of seeds at each study visit. Patients in the control group continued their usual diet without supplementation. Most patients (95%) took the seeds for 6 months (range, 3 to 9 months).

Each patient's body mass index was recorded and complete blood counts were done weekly or monthly, depending on the patient's treatment protocol. The incidence of FN, any hospital admissions, and hospital LOS were recorded during the patient's treatment.

The authors report that the number of FN episodes requiring hospitalization was significantly lower in the black cumin group (2.2%; 8/372) compared with the control group (19.3%; 63/327) (P = 0.001). The median LOS per episode in the black cumin group was 2.5 days compared with 5 days in the control group (P = 0.006). During the trial, a number of children became underweight; however, the 15.7% loss of body weight in the black cumin group was significantly less than the 30.4% loss in the control group (P = 0.048).

These findings could be due to the lower incidence of FN and shorter hospital stays in the black cumin group, which could mean "less negative consequences that may have an impact on children's psychological status and thus feeding." It could also be due to the gastroprotective effects of black cumin seeds against the effects of chemotherapy on gastric mucosa evident in many animal studies, "which may have decreased the gastric pain felt by children upon ingestion of several food items, thus enhancing their food intake and thereby their nutritional status," explain the authors.

A decline in hemoglobin levels observed in the black cumin group is similar to findings from a 2013 study¹ of 40 children with acute lymphoblastic leukemia who showed decreased hemoglobin levels and increased leukocyte counts after consuming black cumin seeds. "These decreases in hemoglobin levels shown by children with cancer upon administering the seeds might be due to the use of a combination of myelotoxic chemotherapeutic drugs which may have exerted an additive toxicity on hemoglobin," write the authors.

This study did not use a placebo (one limitation of the study) because the structure of whole black cumin seeds makes it difficult to find a placebo that is similar and without confounding effects. The study was also limited by the reliance on the parents to provide the exact daily dosing of the seeds at home.

The authors conclude that the black cumin seeds "showed a decrease in incidence of FN in children with brain tumors with shortening of subsequent LOS which may improve their outcome and thereby quality of life."

No conflict of interest was reported.

―Shari Henson

Reference