ALL-661 The Effect of Scalp Cooling in Ameliorating Chemotherapy-Induced Alopecia in Children With Acute Lymphoblastic Leukemia: A Prospective Nonrandomized Trial

• Published in: Clinical lymphoma, myeloma and leukemia Vol. 24; p. S279
• Main Authors: Kumar, Rahul, Gupta, Aditya Kumar, Jana, Manisha, Bansal, Shivam, Prakash, Satya, Meena, Jagdish Prasad, Seth, Rachna
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.09.2024
• Subjects: ALL; chemotherapy-induced alopecia; scalp cooling; scalp cooling; chemotherapy-induced alopecia; ALL
• ISSN: 2152-2650
• DOI: 10.1016/S2152-2650(24)01129-7

Chemotherapy-induced alopecia (CIA) is a common and distressing adverse event in children undergoing chemotherapy. Scalp cooling (SC), although effective in adults in preventing CIA, has not been investigated in children. To investigate the effect of SC in ameliorating CIA in children with ALL Prospective nonrandomized open-label trial. Single tertiary care center in India. Children <15 years of age with confirmed intermediate-risk (IR) or high-risk (HR) acute lymphoblastic leukemia (ALL) undergoing induction chemotherapy were alternately assigned to either SC or control group. SC was done with a precooled Elasto-Gel cap (scalp temperature maintained <25˚C), from 30 minutes before chemotherapy infusion (daunorubicin + vincristine) to 30 minutes after. The primary outcome was successful hair preservation, defined as NCI CTCAE v5.0 alopecia scale grade 1 at the end of induction chemotherapy (EOI). Secondary outcomes included changes in ultrasonographically measured scalp parameters, namely dermal thickness (DT), hair follicle depth (FD), follicle width (FW), and interfollicular distance (IFD). Twenty-two children with a median age of 6 years (range, 3-13 years) were enrolled (13 with IR-ALL and 9 with HR-ALL). One child of 11 in the SC group and 2 children of 11 in control group died before the end of induction. Nine of 10 (90%) in the SC group and 2 of 9 (22%) in the control group had successful hair preservation (P=0.005). Among sonographic parameters, changes in DT (–0.02 vs –0.24 mm; P=0.016) and FW (–0.02 vs –0.08 mm; P=0.042) were significantly less in the SC group. Changes in FD and IFD were not significantly different between the 2 groups. None of the subjects reported headache during SC. Among children with ALL undergoing induction chemotherapy, those who underwent SC were more likely to have successful hair preservation after EOI. There was a significantly lesser decline in DT and FW in the SC group. Larger studies investigating the role of SC in children with cancer are warranted.