Is Hair Loss a Common Side Effect of Multiple Myeloma Treatment?

Hair loss (alopecia) can happen with certain multiple myeloma treatments, but it varies widely by drug regimen and is not universal. Traditional chemotherapy agents (like melphalan, anthracyclines, vincristine) are more likely to cause temporary hair loss, whereas many modern myeloma therapies (such as proteasome inhibitors and monoclonal antibodies) have lower rates or only mild thinning. [PM9] When chemotherapy does cause alopecia, it typically starts 2–3 weeks after treatment begins and is usually reversible, with regrowth over months after therapy ends. ^{[1] [2]} New hair may grow back with a different texture or color, and these changes are often temporary. ^[1]

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How Common Is Hair Loss by Treatment Type?

• Alkylating agents (e.g., high‑dose melphalan): Frequently cause reversible alopecia as part of expected side effects. [PM9]
• Anthracyclines (e.g., doxorubicin): Conventional forms often cause alopecia; pegylated liposomal doxorubicin was designed to reduce alopecia frequency compared with conventional doxorubicin. [PM8] Regimens substituting pegylated liposomal doxorubicin for conventional doxorubicin have reported less alopecia than older combinations. [PM7]
• Vincristine combinations: Alopecia has been observed and is typically reversible. [PM11]
• Proteasome inhibitors (e.g., bortezomib): Alopecia can occur but is usually less common; clinical labeling lists alopecia among dermatologic events. ^{[3] [4]}
• Immunotherapies (e.g., daratumumab): Alopecia is not a prominent adverse effect in labeling and large trials; other side effects are more typical. ^[5]
• Radiation to the head/scalp: Can cause localized scalp hair loss; regrowth may be incomplete depending on dose and field. ^[1]

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Typical Timing and Pattern

• Onset: Hair shedding often begins about 2–3 weeks after starting chemotherapy, with more noticeable loss by 3–6 weeks. ^[2] You may first see hair on the pillow, in the shower, or when brushing. ^[2]
• Distribution: Scalp is most affected; eyebrows, eyelashes, and body hair can also thin, depending on the regimen and dose. ^[1]
• Regrowth: Hair commonly returns after treatment concludes, though texture or color can temporarily differ. ^[1]

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Prevention and Management Strategies

Scalp Cooling (Cold Caps)

• What it is: Cooling the scalp during and shortly after chemotherapy to reduce blood flow and drug uptake by hair follicles. ^[6]
• Effectiveness: Can prevent moderate (grade 2) hair loss in roughly half or more of people, depending on the chemo regimen, with better results in regimens less toxic to hair follicles. ^[6]
• Considerations: Availability, cost, and suitability depend on your exact drugs and schedule. Discuss with your care team.

Choosing Regimens with Lower Alopecia Risk

• Pegylated liposomal doxorubicin may be associated with less alopecia than conventional doxorubicin while maintaining efficacy in relapsed/refractory myeloma, especially when combined with bortezomib. [PM8] Substituting liposomal anthracyclines has been reported to reduce alopecia compared with older anthracycline regimens. [PM7]

Gentle Hair Care

• Use mild, fragrance‑free shampoos, avoid heat styling, tight hairstyles, and harsh chemical treatments to minimize breakage and scalp irritation during treatment. ^[1]
• Shorter hairstyles, soft brushes, and satin pillowcases can help reduce friction and hair pull while shedding is ongoing. ^[1]

Comfort and Camouflage

• Soft hats, scarves, and wigs can provide warmth and cosmetic coverage; many centers offer guidance and fittings. ^[1]
• Brows and lashes: Consider gentle brow pencils and false lashes designed for sensitive skin if thinning occurs. ^[1]

Scalp and Skin Care

• Keep the scalp moisturized and protected from sun exposure (SPF hats or sunscreen) to reduce sensitivity and sunburn risk during and after hair loss. ^[1]

Emotional Support

• Hair changes can be distressing; oncology nurses, social workers, and support groups can offer coping strategies and peer advice. ^[1]

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When to Talk to Your Care Team

• If hair loss is rapid or accompanied by scalp pain, burning, or rash, let your team know to assess for dermatitis or other causes. ^[1]
• Ask whether scalp cooling is appropriate for your specific regimen and schedule, and whether dose adjustments or regimen alternatives could reduce hair toxicity while maintaining cancer control goals. ^[6] [PM8] Not all drugs pair well with scalp cooling, and effectiveness varies, so individualized guidance is important. ^[6]

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Summary Table: Hair Loss Risk Across Common Myeloma Treatments

Treatment class	Examples	Alopecia likelihood	Key notes
Alkylating agents	High‑dose melphalan	High (temporary)	Regrowth expected; part of transplant conditioning. [PM9]
Anthracyclines (conventional)	Doxorubicin	Moderate–High	Frequently causes alopecia. [PM7]
Anthracyclines (liposomal)	Pegylated liposomal doxorubicin	Lower vs conventional	Less frequent alopecia; watch for hand‑foot syndrome. [PM8] [PM10]
Vinca alkaloids	Vincristine (in combos)	Moderate	Typically reversible. [PM11]
Proteasome inhibitors	Bortezomib	Low–Moderate	Alopecia reported but less common than with traditional chemo. [3] [4]
Monoclonal antibodies	Daratumumab	Low	Alopecia not prominent in labeling. [5]
Radiation (head/scalp)	Cranial fields	Variable	Localized hair loss; regrowth depends on dose. [1]

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Key Takeaways

• Hair loss is common with some myeloma chemotherapies, but not with all modern treatments. [PM9] [PM8] If it occurs, it usually starts within weeks of therapy and is reversible. ^{[2] [1]}
• Scalp cooling is the most established method to reduce chemo‑related hair loss, with effectiveness varying by regimen. ^[6]
• Discuss your exact treatment plan to understand your personal alopecia risk and the best prevention and care options. [PM8] ^{[6] [1]}

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