Long-term hair loss associated with brentuximab vedotin–containing chemotherapy and its psychosocial impact: A retrospective observational study conducted at the Royal Marsden Hospital.

Abstract

e19036 Background: Alopecia is a recognised toxicity of Brentuximab Vedotin (BV), but data on the duration and long-term psychosocial consequences are limited. This study aimed to characterise the patterns of BV-associated alopecia and its impact on patient wellbeing. Methods: Patients diagnosed with Hodgkin’s Lymphoma, aged 16 years or above who received Brentuximab Vedotin along with AVD (Adriamycin, Vinblastine, Dacarbazine) were included. All patients had a minimum follow-up of 12 months post completion of chemotherapy. A structured, patient-completed questionnaire captured responses about patterns of hair loss, and various domains of patient wellbeing. Alopecia was graded using CTCAE criteria. Results: Thirteen patients were included, median age 45(range 16-60); female: male (9:4). Twelve (92%) patients completed six cycles of BV+AVD. All patients (100%) experienced generalised alopecia after starting treatment, with a median onset of 4 weeks. One patient had pre-existing androgenic alopecia. Hair regrowth after stopping chemotherapy was reported as normal in 8/13 (61.5%), while 5/13 (38.5%) had persistent abnormal regrowth at a median follow-up of 27 months (range 12-62 months) after treatment. Among these, one reported grade 2 and four reported grade 1 alopecia. Four patients attempted dermatologic treatments with minimal benefit. Qualitative comments highlighted substantial heterogeneity: some patients embraced hair loss or viewed it as an expected treatment effect, while others reported profound self-consciousness, changes in identity, avoidance of social situations, and persistent difficulty moving beyond the “cancer patient” identity. Eyebrow and eyelash loss were described as particularly distressing. Conclusions: Despite brentuximab vedotin’s wide use and favourable therapeutic profile, this evaluation highlights a crucial and under-recognised toxicity. Nearly 40% of patients reported persistent alopecia more than two years after treatment, with significant psychosocial consequences. The prolonged nature of hair loss underscores the need for further research into the mechanisms underlying BV-associated alopecia, to better guide prevention, counselling, and supportive interventions as this valuable therapy continues to be widely used. Patient-Reported QoL Outcome Percentage Reduced self confidence 29 Reduced willingness for social activities 29 Emotional distress related to alopecia 36 Difficulty accepting changes in appearance 36 Felt adequately supported (family/friends/healthcare staff) 64 Reported insufficient support 21 Financial burden from hair-loss treatments 14