Quality of life among older adults undergoing hematopoietic stem cell transplantation: a narrative review

INTRODUCTION: With the global aging population and the expanded application of hematopoietic stem cell transplantation (HSCT) in older adults, understanding quality of life (QOL) outcomes in this vulnerable group is of paramount importance. OBJECTIVES: This narrative review synthesizes current evidence to (1) describe the trajectory of QOL in older HSCT recipients; (2) identify the key transplant-related, physiological, and psychosocial determinants of post-transplant well-being; and (3) evaluate existing and emerging strategies to improve patient outcomes. METHODS: A literature search was conducted in PubMed/MEDLINE, Web of Science, and Embase (inception to December 2024) using terms related to HSCT, older adults, and QOL. Articles focusing on patients aged ≥60 years were selected to synthesize evidence on QOL outcomes, influencing factors, and interventions. RESULTS: Older adults experience significant QOL decline, typically nadiring within three months post-transplant, with infrequent full recovery to baseline. Key determinants include transplant modality (allogeneic vs. autologous), regimen intensity, and complications like graft-versus-host disease. These interact with patient-specific factors such as frailty, nutritional status, psychological distress, and social support. Emerging multidisciplinary strategies, including optimized conditioning regimens, structured psychosocial support, and geriatric assessment-informed enhanced recovery programs, show promise in mitigating QOL impairment. DISCUSSION: The evidence highlights the multifactorial nature of QOL in this population. A critical gap remains the lack of standardized, HSCT-specific geriatric assessment tools to guide personalized interventions. While multidisciplinary care is advocated, its components require further refinement and validation for older adults. CONCLUSION: A holistic, patient-centered approach integrating geriatric principles is essential to improve long-term survivorship and QOL in the growing population of older adults undergoing HSCT.