Autologus Stem Cell Transplatation as a Care Option in Elderly Patients. A Review

Abstract

The ageing population and the increase in life expectancy have put new social and health questions into the public health agenda of western countries. Hematological cancer incidence peaks in older population as a logical consequence of a longer lifespan promoting prolonged exposure to carcinogens and accumulation of genetic alterations. Hematological cancer represents a major cause of mortality in this age group despite recent progress observed in the management of cancer in the general population. Autologous stem cell transplantation (ASCT) represents a therapeutic option in the treatment of a large proportion of lymphomas and multiple myeloma, but their role in the onco-geriatric setting remains an open question, due to the presence of chronic disease. Ageing is characterized by progressive decrements in physiologic reserves and abilities to compensate for physical and/or functional limitations, which increase the risk of developing morbidity and disability. These events explains the extreme diversity of ageing individuals in terms of clinical and functional status. As a consequence, life expectancy in the elderly is influenced not only by the neoplastic diseases itself but also by the various co-morbidities common to this age group. The management of elderly people with hematological diseases potentially curative, should therefore combine both geriatric and tumor assessments. Among the elderly patients identified as being candidates for AHSCT, after the mobilization of progenitor cells from the bone marrow into the peripheral blood, the aphaeresis procedure is the most common method for collecting an adequate number of stem cells. The proper selection of patients may greatly improve the results and the toxicity related to cancer treatment in the elderly. We recommend the adoption of some form of geriatric assessment in the evaluation of any patient who is 70 years and older, this review intends to offer an overview of the state of art in ASCT in elderly patients.

Very Low Rate of Readmission after an Early Discharge Outpatient Model for Autografting in Multiple Myeloma Patients: An Italian Multicenter Retrospective Study

“…High-dose chemotherapy (HDC) followed by autologous stem cell transplantation (ASCT) [1,2] remains the standard of care for young medically fit patients with multiple myeloma (MM) [3][4][5]. Recent studies also suggest that induction therapy with so-called new drugs before transplantation may improve clinical outcomes [6,7].…”

High-Dose Chemotherapy and Autologous Stem Cell Transplant in Older Patients with Lymphoma

“…By evaluating cognitive status, socioeconomic issues and support, depression, polypharmacy, nutrition, ability to perform specific daily tasks independently, comorbidities, and other geriatric syndromes, the CGA may help recognize the older patients who are at increased risk for morbidity, mortality, and chemotherapy toxicity [49, 50]. Although the CGA has yet to be validated in this setting, a multidisciplinary team approach that includes a geriatrician, nutritionist, pharmacist, social worker, psychiatrist/psychologist in addition to the hematology/transplant team might ultimately be of benefit when evaluating older patients for HDT/ASCT [51]. …”

Quality of life in patients with multiple myeloma: early rehabilitation is need of the hour

“…Bortezomib, carfilzomib), high dose chemotherapy plus stem cell transplantation and maintenance therapy. [6][7][8][9][10][11][12] While there has been significant improvement in survival of these patients, many patients continue to have symptoms related to bone damage (pain, deformity, limited range of motion, upper and lower extremity dysfunction or persistent neurological deficits), therapy related side effects (fatigue, anorexia, constipation, dysphagia, neuropathy, gait disturbance, myopathy, osteoporosis etc. ), sleep disturbance, anxiety, depression, along with co morbidities of old age.…”