Research suggests that there is no long-term advantage, in terms of cardioprotection or event-free survival, from giving continuous instead of bolus doxorubicin infusion in children with acute lymphoblastic leukemia (ALL).
"Continuous infusion of doxorubicin and other anthracyclines is currently included in pediatric treatment protocols on the basis of results from short-term studies of adults that suggest continuous anthracycline infusion is cardioprotective," say Steven Lipshultz (University of Miami Miller School of Medicine, Florida, USA) and colleagues.
"Given that we found no difference in cardioprotection between continuous and bolus doxorubicin administration… we encourage pediatric oncology providers treating children with high-risk ALL to minimize or eliminate the use of continuous anthracycline infusion," they suggest.
Lipshultz and colleagues recruited 92 children with ALL who were randomly assigned to treatment with doxorubicin 360 mg/m2 in three-weekly 30 mg/m2 doses given either as a bolus-infusion within 15 minutes (n=43) or continuously over 48 hours (n=49). The children were aged 0.7-16.9 years at enrollment.
As reported in Pediatrics, the researchers studied echocardiograms performed serially on each child, with at least one taken 3 years or more after enrollment.
Although significant cardiac abnormalities in left ventricular structure and function were seen in both groups of children compared with baseline, including depressed systolic function, systolic dilation, reduced wall thickness, and reduced mass, there was no significant difference in the number and degree of abnormalities observed between the two treatment groups at follow up.
Event-free survival was also similar in each group at 10 years, at 83% in the continuous- and 78% in the bolus-infusion group.
"To prevent irreversible damage in patients exposed to cardiotoxic agents, cardioprotective strategies must continue to be developed, including sensitive cardiac monitoring to help guide treatment," conclude the authors.
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