Who should consider an autologous stem cell transplant?

Who should consider an ASCT?

Almost everyone should consider an autologous stem cell transplant. We can do autologous stem cell transplants on older patients, most myeloma patients that get diagnosed are in their 60s and 70s, and age is not a barrier. It's really how healthy you are. And how fit you are, and whether you want to do it. So if you can walk into my office, you can have an autologous stem cell transplant. You're fit enough in my book.

What is the fitness criteria for an autologous stem cell transplant? There are a lot of medical criteria that go into that. What we call comorbidities go into how fit someone is. And that includes other medical problems like high blood pressure, diabetes. Have they had strokes? Have they had other cancers? How well their heart is doing, if they're in severe heart failure? Well, they may not be a good candidate because they may not be able to tolerate some of the side effects with the procedure. So we have certain rules on how much your heart has to pump, internal organs like the liver, to make sure there hasn't been significant damage from smoking or other causes or someone who's been drinking heavily or had hepatitis virus that could damage the liver. So we look at all of these things, make a full assessment of the patient. And if all the organs are working reasonably well, we have criteria that we say, hey, this person could probably benefit from this procedure because it has been shown to prolong the period of remission. We offer it to them.

Then there is also choice. Some patients, when they hear about the procedure, they're very scared about side effects. What's going to happen? And it is a very safe procedure with very minimal complications when done in experienced centers. So most people can get through it just fine. I think preparing, as much education as possible is important. When I counsel patients, I spend at least an hour and a half with them telling them about the process of what happens during the procedure, what they can expect. We give them calendars that basically map out exactly when we expect certain side effects to happen.

Is it better to wait until you're in a very good partial response before you consider an autologous stem cell transplant?

The ideal is if you are in VGPR, in very good partial response or complete remission, because then you ask of the chemotherapy because we want to achieve the maximum, the minimal residual disease negativity. And so the high-dose chemotherapy does the last job. If you receive a lot of therapy, you need to always collect the stem cells earlier because after many years of therapy, you're not going to be able to collect.

And also, the patient may become more sick with time or I was just talking with the patient 76, and I told them that if you don't do the transplant now, I'm not going to be able to do it in a few years. You're close to 80, so sometimes you have to choose your transplant also based on what you want to accomplish. The patient's situation, etc.