Abstract
The survival of multiple myeloma (MM) patients significantly increased in the last decades because of the introduction of novel agents (immunomodulatory agents [IMIDs] and proteasome inhibitors). This improvement was also recently seen in patients older than 65 years of age. This was probably related to better supportive measures that translated into a decrease in early mortality rate [1]. Patients older than 65 years of age are generally considered ineligible for high-dose chemotherapy and autologous stem cell transplantation (ASCT), especially in Europe. For younger patients, ASCT is currently the standard of care. ASCT improved overall survival (OS) compared with chemotherapy [2-4], and recently it showed to be superior to chemotherapy plus IMIDs [5]. In the United States, Medicare covers the costs associated with ASCT for patients up to 78 years of age, with a consequent rise in the utilization of ASCT in the elderly population. Results on the efficacy of ASCT in patients older than 65 are not unequivocal. There is only 1 trial that compared reduced-intensity ASCT to chemotherapy plus
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