Many doctors have thought in the past that age should be an automatic ineligibility factor for multiple myeloma patient transplants.

However, Dr. Langren, Dr. Gasparetto, Dr. Landgren, Dr. Hofmeister, and Dr. Voorhees recently got together to discuss this claim. They ultimately debunked it.

Age

These doctors discussed that yes, age can cause other factors which may make a person ineligible for a transplant. However, in and of itself, age should not be a disqualifying factor.

Of course, when older patients ask to store their stem cells for years, a conversation should be had. Additionally, high doses of chemotherapy can worsen outcomes for older patients, even if they are extremely fit prior to the treatment. These patients quickly run out of reserves and can have worse outcomes from undergoing a transplant.

That said, transplants aren’t the only option for older patients. Many other options may lead to an improved quality of life for patients.

Dr. Voorhees also explains that age may not matter at all for some patients. Instead of assessing age, he assesses fitness. He uses geriatric assessment scales to determine how frail a patient is and how they may heal post-transplant. One potential scale is the International Myeloma Working Group (IMWG) scoring system.

Using these types of scales in the clinic more frequently can lead to better outcomes for patients. Most importantly, it can help ensure each patient has the best quality of life that they can.

Other Factors 

Other factors besides age which should be considered are hemoglobin and kidney function. The dose of melphalan in relation to a patient’s kidney function should specifically be examined. Whether or not patients have possible nonalcoholic steatohepatitis (NASH) is important to evaluate.

When a patient is refused a transplant without assessing these other factors, they are not receiving the best care.

Ultimately, if there aren’t any other limitations, doctors should move forward with a transplant for an older patient just as they would with a younger patient.

You can read more about this discussion here.