Should Autologous Stem Cell Transplantation be Considered for Older Patients With Multiple Myeloma?  

At the 2024 Great Debates and Updates (GDU) in Hematologic Malignancies meeting in Los Angeles, California, Amrita Krishnan, MD, City of Hope, Duarte, California, argued for the value of autologous stem cell transplantation for certain patients with multiple myeloma (MM) over the age of 65, emphasizing focusing on the consideration of frailty as a more complex and dynamic concept and measurement.

“I talked a lot about how we'd need to better assess frailty, in regards to the idea of it's more than just performance status—it also includes cognition, polypharmacy, socio-economic factors, and also to understand that frailty is a dynamic concept,” Dr Krishnan explained.

Transcript:

My name is Amrita Krishnan and I am the director of the Briskin Myeloma Center at the City of Hope Cancer Center. I'm here at Great Debates Los Angeles 2024 and today I had a discussion and debate in regards to the role of autologous stem cell transplantation in patients over the age of 65.

I showed data showing that transplanting patients over 65 was as safe as in patients younger than 65. I show that progression-free survival also is the same for patients over 65 and less than 65. Really the biggest determinant of outcome in patients that are older tends to be related to frailty. Frailty is a big driver of outcomes both in the transplant setting in myeloma, as well as in the non-transplant setting.

I talked a lot about how we'd need to better assess frailty, in regards to the idea of it's more than just performance status—it also includes cognition, polypharmacy, socio-economic factors, and also to understand that frailty is a dynamic concept. And so what you see at the initial diagnosis of myeloma hopefully actually will evolve, and patients become less frail as you adequately treat the myeloma.

The last thing I showed data using quadruplet induction from both the PERSES and IMROZ trials, and pointed out that about a quarter of the patients in both trials were actually between 65 to 75 years.

Source:

Krishnan A. Stem Cell Transplant Should Be Offered to Patients over 65 – YES. Presented at the Great Debates and Updates in Hematologic Malignancies Meeting; July 27-28, 2024; Los Angeles, California.