Multiple Myeloma

AbstractThe concept of high-dose therapy (HDT) followed by autologous hematopoietic cell transplantation (AHCT) remains the standard for treating newly diagnosed multiple myeloma in young and in select, fit, elderly patients. The introduction of ImiDs and proteasome inhibitors administered before and/or after HDT/AHCT gave way to the groundbreaking achievement of stringent complete response (sCR), immunophenotypic CR, and molecular CR, in addition to significantly increased CR and CR plus very good partial response rate (VGPR; Table 81.1). In randomized studies, age of participants is limited to 65 years to avoid selection bias and limit toxicities and withdrawal from studies. However, this does not mean that AAHCT is not feasible in older patients. A study whereby the median age of patients was 72 years old concluded that elderly multiple myeloma patients should not be excluded from transplantation displaying good results with melphalan 140 mg/m2. Currently, in many centers, fit patients up to age 70, and even 75 years old, receive AHCT.