Science Highlights
Published on February 17, 2025
Scalp Cooling During Transplantation for Myeloma: Is Hair Loss Avoidable?
by Rahul Banerjee, MD, FACP
One of the most predictable toxicities of autologous stem cell transplantation (ASCT) for multiple myeloma (MM) — even more so than mucositis — is hair loss. That being said, the use of oral cryotherapy (meaning to suck on ice cubes during melphalan administration) has been shown in randomized studies to dramatically lower the risk of mucositis. Can cryotherapy be used for other organs as well — most notably to the scalp to prevent alopecia?
At the 2025 Tandem Meetings | Transplantation & Cellular Therapy Meetings of ASTCT and CIBMTR, an interdisciplinary team from Cedars-Sinai Medical Center described their innovative approach to try this out. In brief, 30 patients undergoing ASCT for MM (either with melphalan 140 mg/m2 or 200 mg/m2, in both cases using split dosing over 2 days) were asked to wear a scalp cooling device for 6 hours on each day of melphalan: 1 hour before administration and 5 hours afterward.
Their results were quite impressive: the median degree of patient-reported hair loss after three months was only 2.5%! In fact, 29 out of 30 patients reported that their degree of hair loss was so slight that a bystander would not be able to recognize that they had just received myeloablative chemotherapy. The device was relatively well tolerated, although some patients noted mild scalp discomfort during the procedure itself.
What’s next for this technology? A larger Phase 3 trial? A push for broader commercial adoption? We asked the lead author Dr. Bob Vescio:
Dr. Vescio’s reply (condensed for space): “I am very excited about the poster/trial results and the outcomes were even better than I had hoped for. The device (Penguin Cold Cap) is already in use in the United States and throughout the world. I chose to use this device for the study because it was already used frequently by patients in our infusion center, typically for women with breast cancer getting chemotherapy.”
“As for a larger trial, I haven’t planned on one because I think the answer has already been obtained. It is safe and effective, and the device/procedure is already in widespread use. The issue now is payment (roughly $1600 for the two applications). Clearly, this is doable for some but not so doable for others. Some patients have used GoFundMe fundraisers, and I’ve been able to use donated funds for others.”
Speaking personally, this is a technology I’m going to look into as well — hopefully insurance companies will also follow suit. Kudos to the authors for such interesting patient-facing research: hopefully someday alopecia will be a rarity rather than the norm with transplantation!
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