Comparing the Cardiotoxic Effects of Continuous Infusion and Bolus Injection of Doxorubicin in Children with Acute Lymphoblastic Leukemia (ALL): A Randomized Clinical Trial

Background: Cardiotoxicity is a common complication associated with chemotherapy drugs. However, limited evidence exists regarding the cardiotoxic effects of continuous infusion versus bolus injection of doxorubicin. Since no comprehensive study has been conducted on this issue in our country—particularly in Yazd city—this study aimed to compare the cardiotoxicity of bolus injection and continuous infusion of doxorubicin in children with malignancy. Materials and Methods: This single-blind randomized clinical trial was conducted on 61 children with acute lymphoblastic leukemia (ALL) who were treated with doxorubicin in the Oncology Department of Shahid Sadoughi Hospital. Patients were randomly assigned into two groups: one group received doxorubicin via bolus injection (n=30), and the other via continuous infusion (n=31). Cardiac function was assessed using echocardiography before treatment and again 6 months after the start of chemotherapy. Data were analyzed using the Chi-square test, and independent T test. A p-value < 0.05 considered statistically significant. Results: The mean age of participants was 9.2 ± 3.5 years. Of the 61 patients, 31 (50.8%) were boys and 30 (49.2%) were girls. Before treatment, all patients had a normal ejection fraction (EF). After 6 months of treatment, 30 patients (96.8%) in the continuous infusion group maintained a normal EF. In contrast, only 24 patients (80%) in the bolus injection group had a normal EF after treatment. The difference between the two groups in terms of EF was statistically significant (p = 0.04). Conclusion: The frequency of cardiotoxicity was significantly higher in the bolus injection group compared to the continuous infusion group. Therefore, continuous infusion may be the preferred method of administering doxorubicin to reduce its cardiotoxic effects in pediatric patients.