High-dose chemotherapy with melphalan and autologous peripheral blood stem cell (PBSC) transplantation offer the best outcomes for multiple myeloma, but this treatment regime nearly always causes complete hair loss, a major deterrent for some patients.
“Over the years, I've had many people refuse the transplant—even though it's been shown to promote remission and extend their life—because losing their hair was a non-starter,” said Robert Vescio, MD, Professor of Medicine and Director of the Multiple Myeloma and Amyloidosis Program at Cedars-Sinai Cancer Institute. “Unfortunately, that decision impacted their outcomes.”
Cold cap therapy may offer new hope for these patients. According to new data presented at the 2025 Tandem Meetings of ASTCT® and CIBMTR® in Honolulu, cryotherapy with a scalp cooling device was shown to prevent nearly any detectable hair loss in patients with multiple myeloma undergoing high-dose melphalan chemotherapy.
“Giving more patients access to cold cap therapy could increase the likelihood of moving forward with stem cell transplantation, which in many cases would improve the quality and duration of their life,” said Christopher LoPiccolo, MSN, AGACNP-BC, a nurse practitioner in the Cedars-Sinai Multiple Myeloma and Amyloidosis Program, who shared the findings in a poster session.
Investigating Cryotherapy for Hair Loss
Oral cryotherapy has long been used at Cedars-Sinai to prevent mouth sores and reduce gastrointestinal side effects from high-dose melphalan, prompting the researchers to explore its potential for preventing hair loss. That led them to investigate scalp cooling—a technique using a tightly fitted, gel-filled cap chilled to 32 to 35°F that the patient wears before, during, and after chemotherapy. By constricting blood vessels in the scalp, it limits chemotherapy exposure to the hair follicles. They found literature supporting the use of scalp cooling to prevent hair loss in patients undergoing chemotherapy for solid tumors but no reports of its use for multiple myeloma or other hematologic malignancies.
“It seemed odd to me that it hadn't been studied,” Vescio said. “From a mechanical standpoint, it seemed like it would work even better for our patients because melphalan has a much shorter half-life (80 minutes) than most chemotherapy drugs used for solid tumors.”
There is a theoretical risk that scalp cooling could reduce chemotherapy's effectiveness in the scalp, but no evidence in the literature suggests a heightened risk. Since multiple myeloma originates in the bone marrow, the cold should not penetrate to the skull bone, where malignant cells would likely reside.
“The device only cools two to three millimeters,” Vescio explained. “For most transplant patients, any remaining disease is within the skull bone, and it doesn't appear the cooling procedure gets to that level.” Additionally, patients typically receive maintenance therapy post-transplant, further addressing this concern. However, they did discuss this theoretical risk with trial patients during consent.
Study Details
The Cedars-Sinai team conducted a trial of 30 patients with multiple myeloma or amyloid light-chain (AL) amyloidosis undergoing an autologous PBSC transplant. They used scalp cooling on both days of melphalan administration to assess its effectiveness in reducing hair loss.
The median age of participants was 66. In addition, 17 were women and 13 were men. “Men and women were both equally excited about the treatment,” LoPiccolo said. Even men with 50 percent hair coverage or less opted for the procedure to prevent further hair loss. All patients received 70 or 100 mg/m2 of melphalan on two consecutive days, with cryotherapy using the Penguin Cold Cap starting 60 minutes before each melphalan dose and continuing for 5 hours post-administration. Researchers documented hair loss and tolerability with questionnaires and photographs.
The results were striking. All 30 patients reported that a stranger would never suspect they had undergone chemotherapy by looking at their hair. Hair loss was minimal to non-existent in all patients, and the procedure was well-tolerated. The main complaint was scalp discomfort from the cold.
“It can be uncomfortable at the beginning, but the nerve endings get numb as the treatment goes on, and it becomes much more tolerable,” Vescio said. None of the patients experienced any skin reactions or toxicity, and all but one patient said they would repeat the procedure.
LoPiccolo recalled one patient in particular who he's known for years. She had delayed the transplant for as long he's known her because of her fear of hair loss. “As soon as this was available, she was ready,” he said. “It was so exciting to see her do so well, keep her hair, and ultimately receive treatment that's going to extend her life. I asked her, ‘Would you do this again?’ And she said, ‘In a heartbeat.’ It was a full-circle moment for me because that's exactly why we did this.”
Vescio and LoPiccolo noted that cost could be a barrier to broader adoption. Study participants underwent the procedure for free, but standard pricing is about $1,600 for the treatment they received.
“Even off-study, people are paying out of pocket to get it because there is such a demand and desire for this treatment,” LoPiccolo said. Cold cap therapy is now being offered as standard of care at Cedars-Sinai, and he hopes to see it expand.
“I'm so glad we have this at Cedars, but I would love to see it available for patients elsewhere,” LoPiccolo said. “I hope it will become standard of care to at least offer cryotherapy as an option for these patients.”
Colleen Donnelly is a contributing writer.
