Analyzing Comprehensive Health of Patients With Multiple Myeloma for Transplant Decision-Making

At the 2024 Great Debates & Updates (GDU) in Hematologic Malignancies meeting in New York, Ashley Rosko, MD, The Ohio State University, Ohio, shares expert insight on why the comprehensive health of patients with multiple myeloma (MM) should be analyzed to make transplant decisions, rather than only focusing on patient age. 

Transcript:

Hi, my name is Ashley Rosko. I'm a professor at the Division of Hematology at The Ohio State University. I'm a myeloma physician and the medical director of the onco-geriatric program there. My talk today at the Great Debates and Updates in Hematologic Malignancies [meeting] here in New York City was focused on transplant. Particularly, we wanted to be able to [ask], in my portion of the presentation, should transplant be offered to patients older than age 65? My answer was no.

When it comes to this question, I think the main take-home message from my presentation was focused on the fact that age can be used to frame a decision for a patient, but it shouldn't be used to guide the entire treatment decisions. Importantly, when it comes to older adults with multiple myeloma as a whole, the bulk of that therapy is non-transplant based, actually.

When it comes to multiple myeloma patients, depending upon the registry, only 9% of patients actually ever receive a transplant. It tends to be pretty even for patients who are age 65 and older, it's about 50-50 in terms of whether or not a patient can receive a transplant. But the data that I really presented focused on the cost of transplant in terms of health-related quality of life, changes in cognitive impairment, and changes in physical function.

I think that all these measures, when it comes to an adult diagnosed with multiple myeloma, should be assessed before any transplant decisions are made. If a patient [is] identified to have a vulnerability in one of these areas, it's important for that vulnerability to be able to be optimized prior to a transplant. 

So, the take-home message from my presentation was really focused on the fact that age should not be used as a metric for transplant, but rather the overall health and comprehensive health of an individual should be used to make transplant decisions.

Source: 

Rosko A. Debate - Should Stem Cell Transplant Be Offered to Patients over 65? – NO. Presented at the 2024 Great Debates & Updates in Hematological Malignancies: April 5-6, 2024. New York City, NY.