Frailty and Nutrition Significantly Impact Stem Cell Transplant Outcomes in Multiple Myeloma

For patients with multiple myeloma (MM) undergoing autologous stem cell transplant (ASCT), both frailty status and nutritional biomarkers play a crucial role in determining post-transplant outcomes and the risk of toxicity, according to recent research presented at the 2026 Tandem Meetings of the American Society for Transplantation and Cellular Therapy (ASTCT) and Center for International Blood and Marrow Transplant Research (CIBMTR).¹ The study highlights the importance of a comprehensive assessment of patients before and after transplant to optimize care and improve results.

Understanding the Study

Researchers led by Angela Zhang, MD, PhD, of Stanford University, conducted a retrospective analysis of 76 patients diagnosed with MM who received ASCT at a single academic transplant center in 2024.¹ The study aimed to identify how pre-existing frailty and nutritional status influence progression-free survival (PFS), non-relapse mortality (NRM), and infectious toxicity.

Assessing Frailty and Nutritional Status

The investigators utilized the International Myeloma Working Group (IMWG) Simplified Frailty Score to categorize patients as fit (0), intermediate (1), frail (2), or ultra frail (3+). This score incorporates factors such as age, the Charlson Comorbidity Index, and performance status (ECOG).¹

Nutritional status was evaluated using several biomarkers:

• BMI: Body Mass Index, a measure of body fat based on height and weight.
• Serum Albumin: A protein in the blood used as a marker of nutritional and inflammatory status.
• Neutrophil to Lymphocyte Ratio (NLR): An indicator of systemic inflammation.

These biomarkers were measured before the transplant and at 1 month, 3 months, 6 months, and 1 year post-transplant.¹

Key Findings

The average age of participants was 60.8 years, with 66% being male and 50% having high-risk cytogenetics.¹ The baseline frailty distribution revealed that 34% were fit, 38% were intermediate, 25% were frail, and 3% were ultra frail.¹

• Frailty and Response: Baseline frailty category was not associated with achieving a complete response (CR) to treatment (P=0.596).¹ 97% of patients achieved at least a partial response.
• Nutritional Biomarkers: Serum albumin levels increased at three months post-transplant but returned to baseline by six months. BMI decreased significantly at all post-ASCT time points.¹ NLR declined sharply from baseline across all time points.
• Infections: Clinically significant infections were observed in nine patients at one month and four at six months post-transplant, but there was no correlation between frailty and infection rates (P=0.82).¹ Though, patients who experienced early infections had lower baseline BMI.
• Ultra Frail Patients: All patients categorized as ultra frail at baseline remained in that category throughout the one-year follow-up period.¹ Disease progression and the single patient death observed in the study occurred within this ultra-frail group.

Implications for Patient Care

The study underscores the importance of considering both frailty and nutritional status when evaluating patients for ASCT. Whereas baseline frailty did not directly impact response rates or early toxicity, lower baseline BMI was associated with an increased risk of early infectious complications.¹ Monitoring nutritional biomarkers post-transplant can provide valuable insights into patient recovery and potential risks.

Future Directions

Further research is needed to explore interventions aimed at improving nutritional status and mitigating frailty in MM patients undergoing ASCT. Optimizing pre-transplant conditioning and post-transplant supportive care based on individual patient characteristics may lead to improved outcomes and reduced toxicity.

¹ Zhang, A., et al. (2026). How Do Frailty and Nutritional Status Affect Patient Transplant Outcomes in Multiple Myeloma Care. cancernursingtoday.com. https://www.cancernursingtoday.com/post/how-do-frailty-and-nutritional-status-affect-patient-transplant-outcomes-in-multiple-myeloma-care