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Post-Transplants Events

Six cases of permanent alopecia after various conditioning regimens commonly used in hematopoietic stem cell transplantation

Bone Marrow Transplantation volume 40, pages 979–982 (2007)Cite this article

Abstract

Alopecia, a side effect of chemotherapy, is usually temporary and reversible. Irreversible alopecia has been reported after high-dose chemotherapy (HDC) and hematopoietic stem cell transplantation (HSCT) especially related to BuCy containing conditioning regimens; however, the overall incidence is not known. We conducted a retrospective study to identify patients with chemotherapy-induced permanent alopecia after HSCT. We describe six such patients, two males and four females, among 760 patients transplanted between 1997 and 2004. Median age was 45 years (range, 37–65). There were three Caucasians and three African-Americans. Median follow-up was 30 months. Conditioning regimens included BuCy, Bu/Cy and etoposide (VP16) (one of these patients received second autograft after Cy and TBI) and CyVP16 and TBI. Our data show that permanent alopecia is a significant long-term side effect of HSCT and can be seen across the spectrum of diseases and transplant types and with non-busulfan containing regimens. We have observed that patients usually accept permanent alopecia as the price for the cure and therefore true incidence of permanent alopecia may be underestimated. Our findings may also have medico legal and psychosocial implications that need to be taken into consideration when consenting patients for HSCT.

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References

  1. Dorr VJ . A practitioner's guide to cancer-related alopecia. Semin Oncol 998; 25: 562–570.

    Google Scholar 

  2. Hussein AM . Chemotherapy-induced alopecia: new developments. South Med J 1993; 86: 489–496.

    Article  CAS  PubMed  Google Scholar 

  3. Baxley KO, Erdman LK, Henry EB, Roof BJ . Alopecia: effect on cancer patients’ body image. Cancer Nurs 1984; 7: 499–503.

    Article  CAS  PubMed  Google Scholar 

  4. Tran D, Sinclair RD, Schwarer AP, Chow CW . Permanent alopecia following chemotherapy and bone marrow transplantation. Australia J Dermatol 2000; 41: 106–108.

    Article  CAS  Google Scholar 

  5. 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.

    CAS  PubMed  Google Scholar 

  6. Vowels M, Chan LL, Giri N, Russell S, Lam-Po-Tang R . Factors affecting hair regrowth after bone marrow transplantation. Bone Marrow Transplant 1993; 12: 347–350.

    CAS  PubMed  Google Scholar 

  7. 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.

    Article  CAS  PubMed  Google Scholar 

  8. 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.

    CAS  PubMed  Google Scholar 

  9. Tosti A, Piraccini BM, Vincenzi C, Misciali C . Permanent alopecia after busulfan chemotherapy. Br J Dermatol 2005; 152: 1056–1058.

    Article  CAS  PubMed  Google Scholar 

  10. World Health Organization. Handbook for Reporting Results of Cancer Treatment. WHO publication no. 48, WHO: Geneva, 1979.

  11. Massey CS . A multicenter study to determine the efficacy and patient acceptability of the paxman scalp cooler to prevent hair loss in patients receiving chemotherapy. Eur J Oncol Nurs 2004; 8: 121–130.

    Article  PubMed  Google Scholar 

  12. Munstedt K, Manthey N, Sachsse S, Vahrson H . Changes in self-concept and body image during alopecia induced cancer chemotherapy. Support Care Cancer 1997; 5: 139–143.

    Article  CAS  PubMed  Google Scholar 

  13. de Boer-Dennert M, de Wit R, Schmitz PI, Djontono J, v Beurden V, Stoter G et al. Patient perceptions of the side-effects of chemotherapy: the influence of 5HT3 antagonists. Br J Cancer 1997; 76: 1055–1061.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. McGarvey EL, Baum LD, Pinkerton RC, Rogers LM . Psychological sequelae and alopecia among women with cancer. Cancer Pract 2001; 9: 283–289.

    Article  CAS  PubMed  Google Scholar 

  15. Hassan M, Ljungman P, Bolme P, Ringden O, Syruckova Z, Bekassy A et al. Busulfan bioavailability. Blood 1994; 84: 2144–2150.

    CAS  PubMed  Google Scholar 

  16. Tauchmanova L, Selleri C, De Rosa G, Esposito M, Di Somma C, Orio F et al. Endocrine disorders during the first year after autologous stem-cell transplant. Am J Med 2005; 118: 664–670.

    Article  CAS  PubMed  Google Scholar 

  17. Keilholz U, Max R, Scheibenbogen C, Wuster C, Korbling M, Haas R . Endocrine function and bone metabolism 5 years after autologous bone marrow/blood-derived progenitor cell transplantation. Cancer 1997; 79: 1617–1622.

    Article  CAS  PubMed  Google Scholar 

  18. Locatelli F, Giorgiani G, Pession A, Bozzola M . Late effects in children after bone marrow transplantation: a review. Haematologica 1993; 78: 319–328.

    CAS  PubMed  Google Scholar 

  19. Wang J, Lu Z, Au JL . Protection against chemotherapy-induced alopecia. Pharm Res 2006; 23: 2505–2514.

    Article  CAS  PubMed  Google Scholar 

  20. Simister JM . Alopecia and cytotoxic drugs. Br Med J 1966; 2: 1138.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Christodoulou C, Klouvas G, Efstathiou E, Zervakis D, Papazachariou E, Plyta M et al. Effectiveness of the MSC cold cap system in the prevention of chemotherapy-induced alopecia. Oncology 2002; 62: 97–102.

    Article  CAS  PubMed  Google Scholar 

  22. Bleiker TO, Nicolaou N, Traulsen J, Hutchinson PE . Atrophic telogen effluvium from cytotoxic drugs and a randomized trial to investigate the possible protective effect of pretreatment with a topical vitamin D3 analogue in humans. Br J Dermatol 2005; 153: 103–112.

    Article  CAS  PubMed  Google Scholar 

  23. Sredni B, Xu RH, Albeck M, Gafter U, Gal R, Shani A et al. The protective role of the immunomodulator AS101 against chemotherapy-induced alopecia studies on human and animal models. Int J Cancer 1996; 65: 97–103.

    Article  CAS  PubMed  Google Scholar 

  24. Duvic M, Lemak NA, Valero V, Hymes SR, Farmer KL, Hortobagyi GN et al. A randomized trial of minoxidil in chemotherapy-induced alopecia. J Am Acad Dermatol 1996; 35: 74–78.

    Article  CAS  PubMed  Google Scholar 

  25. Granai CO, Frederickson H, Gajewski W, Goodman A, Goldstein A, Baden H . The use of minoxidil to attempt to prevent alopecia during chemotherapy for gynecologic malignancies. Eur J Gynaecol Oncol 1991; 12: 129–132.

    CAS  PubMed  Google Scholar 

  26. Rodriguez R, Machiavelli M, Leone B, Romero A, Cuevas MA, Langhi M et al. Minoxidil (Mx) as a prophylaxis of doxorubicin—induced alopecia. Ann Oncol 1994; 5: 769–770.

    Article  CAS  PubMed  Google Scholar 

  27. Paus R, Handjiski B, Eichmuller S, Czarnetzki BM . Chemotherapy-induced alopecia in mice. Induction by cyclophosphamide, inhibition by cyclosporine A, and modulation by dexamethasone. Am J Pathol 1994; 144: 719–734.

    CAS  PubMed  PubMed Central  Google Scholar 

  28. Shirai A, Tsunoda H, Tamaoki T, Kamiya T . Topical application of cyclosporin A induces rapid-remodeling of damaged anagen hair follicles produced in cyclophosphamide administered mice. J Dermatol Sci 2001; 27: 7–13.

    Article  CAS  PubMed  Google Scholar 

  29. Hesketh PJ, Batchelor D, Golant M, Lyman GH, Rhodes N, Yardley D . Chemotherapy-induced alopecia: psychosocial impact and therapeutic approaches. Support Care Cancer 2004; 12: 543–549.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Medicine, University of Florida, Gainesville Florida, FL, USA

    M Machado, J S Moreb & S A Khan

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  1. M Machado
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  2. J S Moreb
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  3. S A Khan
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Correspondence to S A Khan.

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Machado, M., Moreb, J. & Khan, S. Six cases of permanent alopecia after various conditioning regimens commonly used in hematopoietic stem cell transplantation. Bone Marrow Transplant 40, 979–982 (2007). https://doi.org/10.1038/sj.bmt.1705817

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