Trial reportSupportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer2025
Efficacy of scalp cooling to prevent chemotherapy-induced alopecia in children with acute lymphoblastic leukemia: A non-randomized trial.
Trial report in Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
11 authors.
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Abstract
purposeChemotherapy-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.
methodsWe 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.
resultsTwenty-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.
conclusionSC 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 registrationClinical Trial Registry of India (CTRI/2023/06/054343; registered on 22/06/2023).
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