CONTEXT: Most symptomatic multiple myeloma (MM) patients are elderly (>65 years old). Autologous stem cell transplantation (ASCT) is a standard treatment for patients under 65 years old age, whereas it is a procedure that must be individualized for elderly patients, mainly due to increase in toxicity.
OBJECTIVE: To determinate effectiveness and safety of ASCT in patients older than 65 yrs in a Latin American country.
DESIGN: Retrospective cohort.  We included in the study all myeloma patients who underwent treatment with high dose melphalan and ASCT in our center from January 2008 to November 2017. We compared treatment related mortality and survival between patients ≧ 65 and <65 years old.
Kaplan Meier, Cox regression and Cumulative incidence function tests were used with Stata 13 software.
MAIN OUTCOMES MEASURES: Primary endpoint was overall survival (OS) and  progression free survival (PFS). Secondary endpoints were induction conditioning regimen, time to engraftment, disease response, transplant-related complications and mortality.
RESULTS: We included in the analysis 201 patients; 45 patients were older than 65 yrs (7 patients were over 70 years). There were no significant differences in days of admission, response, complications or  transplant related death.
OS at five years of the entire cohort was 72.2% [95%CI 62.5-79.8]. There was no significant difference in OS at 3 years between patients younger than 65 years and patients older than 65 (81% [95CI% 72.4-87.2] versus 85.8% [95%CI 64.8-94.8], p=0.17). PFS was 37.7 months [95%CI 24.3-45.1]. The median PFS was 29.6 months [96%CI 20.1-45.1] in the younger group and 44.6 months [95%CI 20.1-48.5] in the elderly ones (p=0.967). 
There was a tendency to an increase mortality in patients with more comorbidities in both groups
CONCLUSIONS: In our experience, consolidating induction treatment with ASCT is possible for patients older than 65 years and even in those older than 70 years. The exclusion of patients should be done according to frailty and comorbidities, not according to chronological age. The correct selection of elderly patients makes transplantation a treatment option, even in developing countries.

22 / Experience in autologous stem cell transplantation in elderly multiple myeloma patients