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 beyond age must be considered when evaluating if an ASCT is the right choice. As the global population ages, the incidence of myeloma is expected to rise, making these considerations all the more important. Additionally, transplant centers and specialists have significantly improved their techniques and protocols, enabling them to offer this life-saving option to a growing number of patients.

Key Discussion Points with Your Specialist

As of today, a stem cell transplant should always be discussed with your myeloma specialist. Some aspects to consider when discussing whether ASCT might be a suitable and safe option for you include:

1. Geriatric Fitness & Functional Reserve

The older you get, the harder it can be to recover from a stem cell transplant. 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 never 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, weight, and overall physical health are also considered.

3. Importance of a Reliable 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.

Eligibility for a transplant should also consider that you have the psychological, emotional, practical, and financial support necessary for the entire process.

4. Hospital & Transplant Center Policies

Age restrictions for ASCT vary among hospitals. While some facilities accept only patients under 70, this is not a universal standard. Additionally, certain centers require evaluations by multiple doctors to determine eligibility for ASCT.

Recent research shows that older patients can achieve benefits from ASCT similar to those of younger patients, provided they are otherwise healthy. For this reason, older patients considering ASCT need a personalized strategy to ensure the safest and most effective treatment plan.