A recent study investigated how frailty status and nutritional biomarkers in patients with multiple myeloma (MM) who are undergoing autologous stem cell transplant (ASCT) impact post-transplant and toxicity outcomes.
Angela Zhang, MD, PhD, of Standford University, and colleagues conducted the study and presented their findings during the 2026 Tandem Meetings of American Society for Transplantation and Cellular Therapy (ASTCT) and Center for International Blood and Marrow Transplant Research (CIBMTR).
The investigators explained that they defined nutritional biomarkers as BMI, serum albumin as a “marker of nutritional and inflammatory status,” and neutrophil to lymphocyte ratio (NLR) as “an indicator of systemic inflammation.” In addition, the International Myeloma Working Group (IMWG) Simplified Frailty Score was used to assess frailty status.
The retrospective analysis included 76 patients who met the eligibility criteria of being diagnosed with MM and receiving ASCT via “a single academic transplant in 2024.” The investigators assigned frailty status as fit (0), intermediate (1), frail (2) or ultra frail (3+) based on IMWG simplified frailty score, which incorporated “age, Charlson Comorbidity Index and performance status (ECOG)” information.
Furthermore, the investigators highlighted that nutritional biomarkers were measured before transplant and at 1 month, 3 months, 180 days and 1 year after the procedure. The end points of progression-free survival (PFS), non-relapse mortality (NRM), and infectious toxicity “were analyzed by frailty category” and “longitudinal mixed effects models were fit for each biomarker with predictors of timepoint and best complete response (CR) status.”
The average age of eligible participants was 60.8 years, 66% were male and 50% of patients “had high-risk cytogenetics.” The investigators reported the baseline frailty distribution of patients within the cohort, of whom 34% were classified as fit, 38% as intermediate, 25% as frail, and 3% as ultra frail. They also highlighted that all patients who were categorized as ultra frail remained in that category through post-transplant follow-up at one year.
According to the results, three patients demonstrated disease progression during the study and one patient died, all of whom were categorized as ultra frail at baseline. The researchers underscored that “best response was PR or better in 97% with no significant association between frailty and achieving CR (Fisher’s exact P=0.596).”
Moreover, while serum albumin levels were found to increase at the three-month follow-up point (+0.21 g/dL, P=0.002) and return to baseline by the 180-day follow-up point (P=0.99), BMI was shown to decrease significantly “at all post-ASCT time points (D30 −1.41 kg/m2, P<0.001; D90 −1.35 kg/m2, P<0.001; D365 −0.59 kg/m2, P=0.029).”
The findings further revealed that NLR “declined sharply from baseline across all time points (P<0.001)” and that “no biomarker differed by CR status (interaction P>0.25).” Across toxicity results, the researchers reported that “clinically significant infections” were observed in nine patients at the one-month follow-up point and in four patients at the 180-day follow-up point, with no correlation between frailty (P=0.91) and infection (P=0.82). However, patients with infections at the one-month follow-up time point “had lower baseline BMI than those without infection.”
In reflecting on the results, the investigators highlighted that “albumin and BMI demonstrated temporal changes, whereas NLR declined substantially post-ASCT” and that “lower baseline BMI was linked to early infectious toxicity.”
Among patients with MM undergoing ASCT, “baseline frailty category was not associated with response or early toxicity,” the researchers concluded.
