Patients over 60 with multiple myeloma can benefit from an autologous stem cell transplant (ASCT) and, in many cases, tolerate the procedure well. 

However, several factors should be considered when evaluating whether an ASCT is the right choice. As the global population ages, myeloma incidence is expected to rise, making these considerations increasingly important.

Key Discussion Points with Your Specialist

1. Geriatric Fitness & Functional Reserve

The older you get, the harder it will be to recover. Older adults experience a decline in functional reserve, which can impact their ability to tolerate stress and recover effectively.

Receiving a stem cell transplant at an older age may increase the risk of treatment side effects, cognitive decline, loss of independence, and slower recovery.

However, Age alone is not a deciding factor: Chronological age does not determine fitness for ASCT. A comprehensive evaluation of physical and cognitive health is necessary.

2. Comorbidities & Pre-Transplant Evaluations

Older patients often have additional health conditions that may influence transplant outcomes. Your oncologist will assess chronic conditions (kidney disease, diabetes, high blood pressure, etc.) as well as perform all pre-transplant testing that’s explained earlier in this guide. 

Lifestyle factors such as smoking history, BMI (body mass index), and overall physical activity are also considered.

3. Importance of a Strong Caregiver System

Because the recovery from such an intense procedure is difficult, full time caregiving is essential. Older adults often require more hands-on care during recovery, which can last up to six months.

24-hour assistance is required in the first 30 to 100 days post-ASCT to help with medications, nutrition, and daily tasks, and to watch for signs of infection. 

Keep in mind: 

• Memory problems, depression, and emotional stress may develop and should be monitored.

• Physical therapy and occupational therapy may be needed for mobility and strength recovery.

Patients should have psychological, emotional, practical, and financial support in place before undergoing ASCT.

4. Hospital & Transplant Center Policies

• Age restrictions vary by hospital: Some centers limit ASCT eligibility to patients under 70, though this is not universal.

• Some centers require a multi-doctor evaluation to determine suitability for ASCT.

• Recent studies show that older patients can achieve similar ASCT benefits compared to younger patients, provided they are otherwise healthy.

For older patients considering ASCT, an individualized approach ensures the safest and most effective treatment strategy.