Drugs such as idarubicin and epirubicin are the second generation of anthracyclines. These agents appear less harmful to the heart and idarubicin also appears to be more potent in killing leukemia cells. In 2009, a third generation anthracycline, a synthetic daunorubicin analog called amrubicin, entered the clinics after studies in patients with small cell lung cancer suggested good efficacy and fewer cardiac side-effects. Another related drug, mitozantrone, may also have fewer side-effects than daunorubicin. It belongs to another family (anthraquinones) but resembles anthracyclines in chemical structure and function. It has proven quite useful in the treatment of leukemias and may also have a role in lymphomas. All of these drugs can also produce substantial hair loss which may begin a week after the first injection. The amount of hair lost varies from individual to individual and is usually restricted to the scalp, although pubic, armpit, and facial hair may also be affected. In almost all cases, the hair grows back completely and this is discussed in chapter 11.