The evolving role of transplant for older adults

Abstract

In recent years, the number and percentage of both allogeneic and autologous transplants being performed in older patients has increased. These trends can be attributed to the aging of the population in general, but also improved transplant methodology making transplant safer and better tolerated. Uptake of allogeneic transplant, which is most commonly performed for acute myelogenous leukemia and myelodysplastic syndrome, has also been affected by the development of nonmyeloablative conditioning regimens. Autologous transplants, most commonly performed for multiple myeloma and non-Hodgkin lymphoma, continue to play an important role in the care of the older patient, and in particular, for multiple myeloma, evidence exists to support the safety of melphalan-based autologous transplant well over the age of 70. The current challenge in the transplant field is to understand which factors affect transplant outcomes, including disease-related and patientrelated factors. While chronologic age plays a role in decision-making, physiologic fitness is likely more important. Increasing data exists to support the use of functional assessments, alone or as part of a comprehensive geriatric assessment. As well, any decision to proceed to transplant must consider the relative merits of nontransplant therapies.