P-156:Cryotherapy Prevents Hair Loss in Multiple Myeloma Patients Undergoing Autologous Peripheral Blood Stem Cell Transplantation

Introduction: The best outcomes for multiple myeloma include the use of high-dose melphalan and autologous peripheral blood stem cell (PBSC) transplantation. Melphalan given prior to the reinfusion of stem cells causes nearly complete hair loss in all patients at the doses used, (CTCAE v5 Grade 2). This outcome is widely expected and leads some patients to avoid doing an otherwise life sustaining procedure. In those that do proceed with the transplant, the alopecia can be emotionally traumatic.

Cryotherapy is commonly used to reduce melphalan side effects in the GI tract during stem cell transplantation (Lilleby et.al. 2006). We, thus, initiated a trial to determine if scalp cooling done on both days of melphalan administration would minimize or even completely prevent hair loss.

Methods: Thirty patients with multiple myeloma or AL amyloidosis undergoing an autologous PBSC transplantation had cryotherapy using the Penguin Cold Cap starting 60 minutes prior to each melphalan administration. All patients received either 70 or 100 mg/m2 of melphalan on 2 consecutive days. The cold caps were applied using manufacturer recommended guidelines (penguincoldcaps.com) and kept on for 5 hours after melphalan was started. Questionnaires were given to patients at Day 0 and 90 during the transplant process to determine tolerability and patient perceived benefit. Photographs were taken at Day -2, 7, 14, 30, 60 and 90 days after the transplant to grade hair loss using the CTCAE v5 guidelines.

Results: To date, 22 of the 30 enrolled patients have reached the 90-day completion date. Hair loss was minimal to non-existent in all patients with no patients having Grade 1 or 2 hair loss. Photographs show minimal difference between pre- and post-transplant time points with essentially no hair loss noticed except at some areas where the scalp cooling device may not have touched the skin. The procedure was well tolerated with the main complaint being scalp discomfort due to cold. No skin reactions or toxicity was observed. Questionnaires document that most patients would do the procedure again.

Conclusions: The Penguin Scalp cooling device can prevent nearly any detectable hair loss in patients with multiple myeloma undergoing high-dose chemotherapy and an autologous peripheral blood stem cell transplantation. This result was in marked contrast to the near universal Grade 2 hair loss in patients undergoing a transplant without this procedure. The process is simple, and the patients were overall very pleased with the results. The short 80-minute half-life of melphalan likely explains the better outcomes for multiple myeloma compared to breast cancer patients. This better cosmetic outcome should broaden the usage of high-dose chemotherapy and thus improve overall quality and quantity of life. Final results of the trial including photographs and questionnaire results will be available in time for the conference.