Recently Diagnosed or Relapsed? Stop Looking For a Miracle Cure, and Use Evidence-Based Therapies To Enhance Your Treatment and Prolong Your Remission
Multiple Myeloma an incurable disease, but I have spent the last 25 years in remission using a blend of conventional oncology and evidence-based nutrition, supplementation, and lifestyle therapies from peer-reviewed studies that your oncologist probably hasn't told you about.
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Should 70+ Myeloma Patients Transplant?
Should 70 + year old myeloma patients have a transplant aka autologous stem cell transplant? What does the research say?
The FDA approved standard-of-care health plan for all newly diagnosed MM patients is:
- Induction therapy (usually DVRd- 6-8 cycles)
- An autologous stem cell transplant (ASCT)
- low-dose maintenance therapy (usually revlimid)
It is my experience that the vast majority of board certified oncologists will encourage an ASCT. Oncology usually subscribes to the “control” side of the cure vs. control debate.
Regardless of your therapy plan, consider prehabilitation before you begin treatment of any kind.
What are the pros and cons of newly diagnosed myeloma patients who are age 70 and older having an autologous stem cell transplant?
For newly diagnosed multiple myeloma (MM) patients aged 70 and older, an autologous stem cell transplant (ASCT) can be a treatment option, but it comes with both potential benefits and risks. Here’s a breakdown:
Pros of ASCT in Older Myeloma Patients
- Prolonged Progression-Free Survival (PFS) – ASCT can extend the time before the disease progresses compared to standard chemotherapy alone.
- Higher Response Rates – ASCT often leads to deeper and more durable responses, including complete remission (CR) or very good partial response (VGPR).
- Potentially Longer Overall Survival (OS) – Some studies suggest ASCT may contribute to improved survival in select older patients compared to non-transplant therapies.
- Feasibility with Modern Supportive Care – With improved supportive treatments (such as better infection control, growth factors, and reduced-intensity conditioning regimens), ASCT is safer for older patients than it was in the past.
- Tolerability in Fit Patients – Chronological age alone is not the sole determinant of transplant eligibility; physiologic fitness and comorbidities are more critical factors.
Cons of ASCT in Older Myeloma Patients
- Higher Risk of Toxicities – Older patients may experience more severe side effects, such as infections, fatigue, gastrointestinal symptoms, and prolonged bone marrow suppression.
- Longer Recovery Time – Stem cell transplant recovery can take several months, during which patients may experience weakness and increased vulnerability to complications.
- Comorbidities Impact Tolerance – Patients with heart, kidney, or lung disease may not tolerate the transplant well, leading to increased complications.
- Quality of Life Concerns – The intensive nature of the procedure may temporarily reduce quality of life, and some older patients may not regain their pre-transplant functional status.
- Alternative Therapies May Be Effective – With advancements in novel agents (such as proteasome inhibitors, immunomodulatory drugs, and monoclonal antibodies), non-transplant regimens may offer comparable survival benefits with fewer risks in some patients.
Key Considerations
- Patient Fitness (Not Just Age) – A comprehensive geriatric assessment, rather than just age, determines ASCT eligibility.
- Reduced-Intensity Conditioning – Using lower doses of chemotherapy (e.g., melphalan 140 mg/m² instead of 200 mg/m²) can improve tolerability.
- Transplant vs. Continuous Therapy – Some older patients may achieve similar long-term outcomes with continuous drug therapy without the risks of transplant.
- Shared Decision-Making – Patients should discuss with their hematologist whether ASCT aligns with their personal health status, preferences, and treatment goals.
The list of pros and cons listed above is what your oncologist will say are the benefits of an ASCT. Unfortunately, the study linked below is a study of actual MM patient experiences. In short, the study documents:
- Longer average progression-free survival (first remission) for patients undergoing ASCT
- Shorter average overall survival (length of life) for patients undergoing ASCT
An autologous stem cell transplant is a lot of toxicity and therefore a higher risk of side effects. Please read the “cons” list repeatedly to understand its significance.
Email me at David.PeopleBeatingCancer@gmail.com with questions about ASCT as well as novel therapies.
Good luck,
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
Outcomes with autologous stem cell transplant vs. non-transplant therapy in patients 70 years and older with multiple myeloma
Abstract
We evaluated 79 patients with multiple myeloma (MM) ≥70 years referred to our blood and marrow transplant clinic, within 1 year of diagnosis from 2010 to 2019, for consideration of autologous stem cell transplant (ASCT).
Thirty-eight (48%) of 79 patients underwent ASCT. ASCT was not pursued in 41 (52%) patients due to: patient or physician preference in 80% (n = 33) or ineligibility in 20% (n = 8). Baseline characteristics of patients in the two groups were similar.
Median PFS from treatment start amongst patients undergoing ASCT (n = 38) vs. not (n = 41) was 41 months vs. 33 months.
There was no difference in OS, with estimated 5-year OS of 73% vs. 83%, respectively. Day +100 transplant-related mortality (TRM) was 0%. ASCT was an independent favorable prognostic factor for PFS in multivariate analysis, after accounting for HCT-CI score, performance status, hematologic response, and maintenance.
Finally, patients ≥70 years undergoing ASCT had similar PFS compared to a contemporaneous institutional cohort of patients <70 years (n = 631) (median PFS from transplant: 36 vs. 47 months, p = 0.25).
In this retrospective analysis, ASCT was associated with low TRM and better PFS in fit older adults with MM compared to non-transplant therapy, with comparable benefits as seen in younger patients…
should 70+ myeloma patients transplant should 70+ myeloma patients transplant