Medline ® Abstracts for References 44-46
Busulfan concentration in relation to permanent alopecia in recipients of bone marrow transplants.
Ljungman P, Hassan M, Békássy AN, Ringdén O, Oberg G
Bone Marrow Transplant. 1995;15(6):869.
Alopecia is an important long-term complication after bone marrow transplantation (BMT). The aim of this study was to analyze the influence of busulfan concentration on the development of permanent alopecia. Sixty five patients who survived for at least 6 months after BMT were studied. The median follow-up was 2.1 years (range 0.5-5.7 years). Thirty one patients (47%) had some degree of alopecia and 19 of these patients had extensive alopecia. The mean minimum busulfan concentration was 656 +/- 222 ng/ml in patients who developed alopecia compared with 507 +/- 224 ng/ml in those who did not (P = 0.005). Patients with more extensive alopecia had higher busulfan concentrations than patients with less significant abnormalities. In multivariate analysis, alopecia was associated with busulfan concentrations higher than the median (OR 3.43; 95% CI 3.04-3.88), allogeneic transplantation (OR 2.56; 95% CI 2.28-2.88) and female sex (OR 1.96; 95% CI 1.73-2.88). There was no association between alopecia and chronic graft-versus-host disease. High busulfan concentrations may contribute to the development of permanent alopecia and the risk for alopecia should be considered when choosing the conditioning regimen before BMT.
Department of Medicine, Huddinge University Hospital, Sweden.
Factors affecting hair regrowth after bone marrow transplantation.
Vowels M, Chan LL, Giri N, Russell S, Lam-Po-Tang R
Bone Marrow Transplant. 1993;12(4):347.
Permanent alopecia after BMT has been reported as a side-effect associated with GVHD or after busulphan conditioning therapy, primarily in adults. We have reviewed children undergoing BMT to document the frequency of incomplete hair regrowth and to evaluate factors associated with this problem. Hair regrowth was studied in 74 children who survived>6 months following BMT undertaken for malignant and non-malignant diseases. Alopecia was categorised as severe (<50% of pre-transplant status), moderate (50-75%) or mild (>75% but less than normal). Overall, 18 (24.3%) of 74 patients had mild (n = 5), moderate (n = 4) or severe (n = 9) alopecia. Risk factors for alopecia were presence of chronic GVHD (67%; p<0.001), older age (p<0.001) and prior cranial irradiation (42%; p = 0.03). Alopecia occurred in children receiving either busulphan (31%) or total body irradiation (16%; p = 0.15) as conditioning therapy. The highest frequency was seen in patients conditioned with busulphan with or without melphalan and who received prior cranial irradiation and/or developed chronic GVHD (75%). These data indicate that alopecia after BMT in children is a significant problem and confirm, in children, the previously noted association between alopecia and chronic GVHD and busulphan. Further risk factors of older age and prior cranial irradiation are identified. Consideration needs to be given to the use of an alternative to busulphan in children who are of older age, have received prior cranial irradiation and/or are at increased risk of GVHD.
Department of Haematology/Oncology, Prince of Wales Children's Hospital, Randwick, Australia.
Clinical characteristics of chemotherapy-induced alopecia in childhood.
Choi M, Kim MS, Park SY, Park GH, Jo SJ, Cho KH, Lee JW, Park KD, Shin HY, Kang HJ, Kwon O
J Am Acad Dermatol. 2014;70(3):499. Epub 2013 Dec 16.
BACKGROUND: Chemotherapy-induced alopecia (CIA) is a frequent complication in patients with cancer. There are an increasing number of reports of permanent CIA.
OBJECTIVE: We investigated the clinical characteristics of CIA, including permanent CIA in childhood.
METHODS: We collected data on 159 pediatric patients who had undergone high-dose conditioning chemotherapy followed by hematopoietic stem cell transplantation and 167 control subjects, using a questionnaire, medical record reviews, and phototrichograms.
RESULTS: Alopecia began at 1.5 ± 1.4 months and was sustained until 2.2 ± 1.6 months after chemotherapy initiation. Hair regrowth started 2.6 ± 1.6 months after chemotherapy ceased and lasted for 7.3 ± 4.9 months. The mean hair density and thickness were 198.3 ± 47.4/cm(2) and 76.3 ± 18.4 μm in the patient group and 229.6 ± 34.5/cm(2) and 79.5 ± 12.4 μm in the control group, respectively (both, P < .001). In all, 19 (12%) patients experienced permanent CIA. Thiotepa use was identified as a significant risk factor for permanent CIA (odds ratio 7.57, P = .002).
LIMITATIONS: Cross-sectional study in a single-center is a limitation.
CONCLUSION: CIA is common in pediatric patients. Use of thiotepa is strongly associated with permanent CIA.
Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea.