What are the effects of stem cell tansplants on hair? What are cryo caps and should they be used during transplant?

Why do myeloma patients lose their hair during an autologous stem cell transplant?
Stem cell transplant itself doesn’t do anything to the hair. It’s the chemotherapy that we use for conditioning. Right. It’s melphalan. So what happened with a melphalan is like the mephalan is a classic chemotherapy agent. Right. And these classic chemotherapy agents, what they do, they just like target the cells that divide rapidly. Like the cancer cells. Any cancer cells devide rapidly because they are growing. So that's where the the chemotherapy and that works. But then the bystanders are the older cells in our body that are normal and that are also dividing rapidly. Those out of the cells of the hair follicles. So those get affected and that's why we have the hair loss. That's that's how it happens. Right. The transplant itself, your stem cells given back to you, those don't have anything to do with that. It’s just the chemotherapy.

Do most myeloma patients lose their hair during transplant?
Most of the patients go through hair loss, right. It could be, a very big issue for most patients. Some patients may say no to a transplant because of that. Right. Because it's a very personal decision. So hair loss is commonly experienced when patient goes through stem cell transplant. It is because of the chemotherapy, melphalan. And, it is the one thing that my patients focus on during their, or often question me, during our stem cell transplant consultation. sometimes, I'm able to comfort them by saying it's temporary and it's going to come back, but at other times, this seems to be the big focus of our discussion, actually. So it's not something to be dismissed.

Has there been any research about the use of a cryo/cold cap to prevent hair loss in myeloma patients going through transplant?
Past in February, in the American Society of Transplant Cellular Therapy, in the tendem meeting, there was this abstract was presented coming from California, from Cedars-Sinai group. And then where they did they have 30 patients. It was small study, but it still is the first study that I have seen about it where they use this cryo cap. Right. What is this cryo cap? It’s basically a cap that is attached to, circulating system that circulates either water or a gel. And this water and gel is set up on in a specific temperature. In this study, the patients who started using the cryo cap about 60 minutes before the chemotherapy was given, and then they continue using the cap for about, five hours. That was what this was planned. In hour actually, the patient have like close to six hours of wearing the cap. Of the 30 patients, none of them have significant hair loss. Right. Like we usually grade hair loss to grade one, grade two or so forth, none of those patients have anything that was noticeable to anybody else or based on their surveys that they have, undergoing chemotherapy, for example. Right. So of all those study patients, only one patient, relapsed, let's say rapidly after transplant. This was a patient with plasma cell leukemia. This study not only included patients with myeloma but also include patients with amyloidosis. Most of the patients were we may however, I will tell like, about, like 40% of the patients were also, male. All of them, we'll say about one, so that they will use that technology again, if that's the case. Right. And then they will recommend it. There is a lot of literature in the breast, oncology world where these cryo caps are used, for, you know, cooling and to prevent, a hair loss over there. And it's quite successful. In the myeloma world that has not been taken up so much, but on a case by case basis, I've had patients who've expressed a deep desire, to preserve their, hair, actually, during the transplant process. So I've actually, you know, on an individual basis, have used them in one case very successfully and another case not so successfully. So, I think we have to learn more about this and how we can, actually study this in myeloma. We don't want to, affect efficacy, and the effectiveness of melphalan. And I think that has been a prior concern.

How does the cryo/cold cap work to prevent hair loss? Is it similar to sucking on ice during the melphalan infusion?
Another side effect that multiple myeloma patients experience during their stem cell transplant is actually mucositis secondary to melphalan. And the way we try to alleviate that is by having patients cool their mouths by sucking on ice, lollies or ice cream or, whatever, you know, that will essentially cool their mouth. And I think the concept is very similar with the cryo caps at the skull as well, that you basically cause vasoconstriction, cause blood vessels to shrink. So less chemo flows there.

Are there any concerns about the use of a cryo/cold cap?
there are concerns about like how it works. Right. The way it works is like by cooling your skull. Right. The blood vessels constrained so that it's not that much exposure to the melphalan. So the question will be whether or not, like you will still have active, myeloma cells not in the skull, but in the bones, you know, then that will be one of the questions, right? Or those patients, the right candidates. What about like, if you have a PET scan before transplant and your PET scan is negative in that area and then probably shouldn't be a big concern, right? I think these studies are going to continue to expand. I think, a more like a multicenter study needs to happen. And then, start looking into that. Right? I only have one patient in my practice that has done this, and he arranged for these, well, let's say independently. Right, because this is not necessarily covered by insurance. Right. I know he's covered for all their concerns, like, for example, breast cancer. However, in breast cancer, it hasn't show the, great effect that we have seeing in these patients with myeloma. Right. Where none of them has a significant loss of hair.