Abstract
Permanent alopecia after haematopoietic stem cell transplantation (HSCT) is distressing and few studies have investigated this late effect. The aim of the study was to assess the percentage of patients with alopecia and investigate risk factors for alopecia. Patients who underwent allogeneic HSCT before age 19 years, from January 1990 to January 2013, who were at least 2 years after transplant and in follow-up in our clinic were included. Alopecia was defined as clinically apparent decreased hair density. Possible risk factors considered for alopecia after HSCT included: gender, age, diagnosis, donor type, conditioning regimen: cranial irradiation (TBI/cranial radiotherapy) and/or chemotherapy, which chemotherapeutic agents were used and acute/chronic GvHD. The percentage of permanent alopecia in our cohort was 15.6% (41/263 patients). All patients had diffuse alopecia except for one with alopecia totalis. In multivariate analysis, a conditioning regimen with busulphan and busulphan plus fludarabine (odds ratio (OR) 5.7 (confidence interval (CI): 2.5–12.7) and OR 7.4 (CI: 3.3–16.2), respectively, was the main risk factor and associated with alopecia independent of acute/chronic GvHD. Neither TBI nor other alkylating chemotherapy, including treosulfan, was associated with alopecia. In conclusion, permanent alopecia after HSCT is associated with busulphan and GvHD and occurs in 16% of patients.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Armenian SH, Sun CL, Kawashima T, Arora M, Leisenring W, Sklar CA et al. Long-term health-related outcomes in survivors of childhood cancer treated with HSCT versus conventional therapy: a report from the Bone Marrow Transplant Survivor Study (BMTSS) and Childhood Cancer Survivor Study (CCSS). Blood 2011; 118: 1413–1420.
Baker KS, Bresters D, Sande JE . The burden of cure: long-term side effects following hematopoietic stem cell transplantation (HSCT) in children. Pediatr Clin North Am 2010; 57: 323–342.
Bresters D, van Gils IC, Kollen WJ, Ball LM, Oostdijk W, van der Bom JG et al. High burden of late effects after haematopoietic stem cell transplantation in childhood: a single-centre study. Bone Marrow Transplant 2010; 45: 79–85.
Nieder ML, McDonald GB, Kida A, Hingorani S, Armenian SH, Cooke KR et al. National Cancer Institute-National Heart, Lung and Blood Institute/pediatric Blood and Marrow Transplant Consortium First International Consensus Conference on late effects after pediatric hematopoietic cell transplantation: long-term organ damage and dysfunction. Biol Blood Marrow Transplant 2011; 17: 1573–1584.
Sun CL, Kersey JH, Francisco L, Armenian SH, Baker KS, Weisdorf DJ et al. Burden of morbidity in 10+ year survivors of hematopoietic cell transplantation: report from the bone marrow transplantation survivor study. Biol Blood Marrow Transplant 2013; 19: 1073–1080.
de Jonge ME, Mathot RA, Dalesio O, Huitema AD, Rodenhuis S, Beijnen JH . Relationship between irreversible alopecia and exposure to cyclophosphamide, thiotepa and carboplatin (CTC) in high-dose chemotherapy. Bone Marrow Transplant 2002; 30: 593–597.
Kinahan KE, Gandhi M, Lacouture ME, Eilers R Jr, Haryani A, Didwania A et al. Dermatologic issues in adult survivors of childhood cancer. J Cancer Surviv 2009; 3: 158–163.
Kinahan KE, Sharp LK, Seidel K, Leisenring W, Didwania A, Lacouture ME et al. Scarring, disfigurement, and quality of life in long-term survivors of childhood cancer: a report from the Childhood Cancer Survivor study. J Clin Oncol 2012; 30: 2466–2474.
Miteva M, Misciali C, Fanti PA, Vincenzi C, Romanelli P, Tosti A . Permanent alopecia after systemic chemotherapy: a clinicopathological study of 10 cases. Am J Dermatopathol 2011; 33: 345–350.
Rogers S, Donachie P, Sugden E, Sharpe G, English M, Robinson K et al. Comparison of permanent hair loss in children with standard risk PNETS of the posterior fossa following radiotherapy alone or chemotherapy and radiotherapy after surgical resection. Pediatr Blood Cancer 2011; 57: 1074–1076.
Tallon B, Blanchard E, Goldberg LJ . Permanent chemotherapy-induced alopecia: case report and review of the literature. J Am Acad Dermatol 2010; 63: 333–336.
Baker BW, Wilson CL, Davis AL, Spearing RL, Hart DN, Heaton DC et al. Busulphan/cyclophosphamide conditioning for bone marrow transplantation may lead to failure of hair regrowth. Bone Marrow Transplant 1991; 7: 43–47.
Machado M, Moreb JS, Khan SA . Six cases of permanent alopecia after various conditioning regimens commonly used in hematopoietic stem cell transplantation. Bone Marrow Transplant 2007; 40: 979–982.
Tosti A, Piraccini BM, Vincenzi C, Misciali C . Permanent alopecia after busulfan chemotherapy. Br J Dermatol 2005; 152: 1056–1058.
Tran D, Sinclair RD, Schwarer AP, Chow CW . Permanent alopecia following chemotherapy and bone marrow transplantation. Australas J Dermatol 2000; 41: 106–108.
Ljungman P, Hassan M, Bekassy AN, Ringden O, Oberg G . Busulfan concentration in relation to permanent alopecia in recipients of bone marrow transplants. Bone Marrow Transplant 1995; 15: 869–871.
Ringden O, Remberger M, Ruutu T, Nikoskelainen J, Volin L, Vindelov L et al. Increased risk of chronic graft-versus-host disease, obstructive bronchiolitis, and alopecia with busulfan versus total body irradiation: long-term results of a randomized trial in allogeneic marrow recipients with leukemia. Nordic Bone Marrow Transplantation Group. Blood 1999; 93: 2196–2201.
Choi M, Kim MS, Park SY, Park GH, Jo SJ, Cho KH et al. Clinical characteristics of chemotherapy-induced alopecia in childhood. J Am Acad Dermatol 2014; 70: 499–505.
Chon SY, Champion RW, Geddes ER, Rashid RM . Chemotherapy-induced alopecia. J Am Acad Dermatol 2012; 67: e37–e47.
Paus R, Haslam IS, Sharov AA, Botchkarev VA . Pathobiology of chemotherapy-induced hair loss. Lancet Oncol 2013; 14: e50–e59.
Palamaras I, Misciali C, Vincenzi C, Robles WS, Tosti A . Permanent chemotherapy-induced alopecia: a review. J Am Acad Dermatol 2011; 64: 604–606.
Yeager CE, Olsen EA . Treatment of chemotherapy-induced alopecia. Dermatol Ther 2011; 24: 432–442.
Sotiropoulou PA, Candi A, Mascre G, De Clercq S, Youssef KK, Lapouge G et al. Bcl-2 and accelerated DNA repair mediates resistance of hair follicle bulge stem cells to DNA-damage-induced cell death. Nat Cell Biol 2010; 12: 572–582.
Socie G, Clift RA, Blaise D, Devergie A, Ringden O, Martin PJ et al. Busulfan plus cyclophosphamide compared with total-body irradiation plus cyclophosphamide before marrow transplantation for myeloid leukemia: long-term follow-up of 4 randomized studies. Blood 2001; 98: 3569–3574.
Andersson BS, Valdez BC, de Lima M, Wang X, Thall PF, Worth LL et al. Clofarabine +/- fludarabine with once daily i.v. busulfan as pretransplant conditioning therapy for advanced myeloid leukemia and MDS. Biol Blood Marrow Transplant 2011; 17: 893–900.
Severs GA, Griffin T, Werner-Wasik M . Cicatricial alopecia secondary to radiation therapy: case report and review of the literature. Cutis 2008; 81: 147–153.
Zuo RC, Naik HB, Steinberg SM, Baird K, Mitchell SA, Kuzmina Z et al. Risk factors and characterization of vitiligo and alopecia areata in patients with chronic graft-vs-host disease. JAMA Dermatol 2015; 151: 23–32.
Acknowledgements
We thank Mrs JDJ Bakker-Steeneveld for providing us with the clinical data of the patients from the EBMT (The European Society for Blood and Marrow Transplantation) registry.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Rights and permissions
About this article
Cite this article
Bresters, D., Wanders, D., Louwerens, M. et al. Permanent diffuse alopecia after haematopoietic stem cell transplantation in childhood. Bone Marrow Transplant 52, 984–988 (2017). https://doi.org/10.1038/bmt.2017.15
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/bmt.2017.15
This article is cited by
-
Treosulfan vs busulfan conditioning for allogeneic bmt in children with nonmalignant disease: a randomized phase 2 trial
Bone Marrow Transplantation (2024)
-
Priming mobilization of hair follicle stem cells triggers permanent loss of regeneration after alkylating chemotherapy
Nature Communications (2019)
-
Kutane Graft-versus-Host-Erkrankung
Der Hautarzt (2018)