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Purpose <p>Chemotherapy-induced alopecia (CIA) is a common adverse event in children undergoing chemotherapy. Scalp cooling (SC), although effective in adults in preventing CIA, has not been investigated in children.</p> Methods <p>We conducted a prospective, non-randomized trial in children with acute lymphoblastic leukemia (ALL) undergoing induction chemotherapy. Participants were sequentially assigned to either SC or non-cooling (NC) groups. SC was done using a pre-cooled Elasto-Gel® cap during chemotherapy infusion (daunorubicin + vincristine). Primary outcome was successful hair preservation (HP), defined as NCI-CTCAE v5.0 alopecia grade-1 at end of induction (EOI). Secondary outcomes included changes in scalp-ultrasonographic and scanning electron microscopic parameters (SEM) along with trichoscopy and trichogram findings.</p> Results <p>Twenty-two children with a median age of 72&#xa0;months (IQR: 60–129) were enrolled. One child in the SC and two in the NC group out of 11 in each, died before EOI. Successful HP was achieved in 9/10 in the SC group versus 2/9 in the NC group (<i>p</i> = 0.005). Amongst the sonographic parameters, there was a significantly lesser decrease in dermal thickness in the SC group (− 0.03&#xa0;mm vs. − 0.3&#xa0;mm,<i> p</i> = 0.049). Amongst the SEM parameters, there was a significantly better preservation of shaft-diameter (− 7.9&#xa0;µm vs. − 21.6&#xa0;µm,<i> p</i> = 0.005) and cuticular scale-density (− 3.5 scales/100&#xa0;µm vs. − 12 scales/100&#xa0;µm, <i>p</i> = 0.0004) in the SC group. Trichoscopic and trichogram findings associated with CIA were more pronounced in the NC group. No subjects reported headaches or dizziness during SC.</p> Conclusion <p>SC was associated with a higher likelihood of successful HP in children with ALL undergoing induction chemotherapy. SC is safe and well-tolerated in children with cancer. Further studies investigating the long-term safety outcomes of SC are needed.</p> Trial registration <p>Clinical Trial Registry of India (CTRI/2023/06/054343; registered on 22/06/2023).</p>

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Efficacy of scalp cooling to prevent chemotherapy-induced alopecia in children with acute lymphoblastic leukemia: A non-randomized trial

  • 期刊论文

  • 发表日期：

    2025年12月1日

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  • Rahul Kumar,
  • Satya Prakash,
  • Shivam Bansal,
  • Rhea Ahuja,
  • Nikhil Mehta,
  • Neetu Bhari,
  • Manisha Jana,
  • Subhash Yadav,
  • Jagdish Prasad Meena,
  • Rachna Seth,
  • Aditya Kumar Gupta

摘要

Purpose

Chemotherapy-induced alopecia (CIA) is a common adverse event in children undergoing chemotherapy. Scalp cooling (SC), although effective in adults in preventing CIA, has not been investigated in children.

Methods

We conducted a prospective, non-randomized trial in children with acute lymphoblastic leukemia (ALL) undergoing induction chemotherapy. Participants were sequentially assigned to either SC or non-cooling (NC) groups. SC was done using a pre-cooled Elasto-Gel® cap during chemotherapy infusion (daunorubicin + vincristine). Primary outcome was successful hair preservation (HP), defined as NCI-CTCAE v5.0 alopecia grade-1 at end of induction (EOI). Secondary outcomes included changes in scalp-ultrasonographic and scanning electron microscopic parameters (SEM) along with trichoscopy and trichogram findings.

Results

Twenty-two children with a median age of 72 months (IQR: 60–129) were enrolled. One child in the SC and two in the NC group out of 11 in each, died before EOI. Successful HP was achieved in 9/10 in the SC group versus 2/9 in the NC group (p = 0.005). Amongst the sonographic parameters, there was a significantly lesser decrease in dermal thickness in the SC group (− 0.03 mm vs. − 0.3 mm, p = 0.049). Amongst the SEM parameters, there was a significantly better preservation of shaft-diameter (− 7.9 µm vs. − 21.6 µm, p = 0.005) and cuticular scale-density (− 3.5 scales/100 µm vs. − 12 scales/100 µm, p = 0.0004) in the SC group. Trichoscopic and trichogram findings associated with CIA were more pronounced in the NC group. No subjects reported headaches or dizziness during SC.

Conclusion

SC was associated with a higher likelihood of successful HP in children with ALL undergoing induction chemotherapy. SC is safe and well-tolerated in children with cancer. Further studies investigating the long-term safety outcomes of SC are needed.

Trial registration

Clinical Trial Registry of India (CTRI/2023/06/054343; registered on 22/06/2023).