Objective: We aim to describe the importance and the reasons to front-line ASCT ineligibility in young MM patients in a tertiary center in São Paulo – Brazil. Methods: We retrospectively reviewed the medical charts of patients, aged between 18 and 69 years, with symptomatic MM diagnosed between January/2001 and july/2017. Baseline clinical features, follow-up data and reason for ASCT ineligibly were collected. Results: We collected data from 481 patients, with 434 remaining after exclusion. Median age was 58 years (27–69 years), 54.6% were males. The proportion of patients at International Staging System (ISS) III was 38.6%. 22 (5.1%) were treated with proteasome inhibitor containing regimens. 212 (48,8%) patients underwent front-line ASCT. The two main reasons for ASCT ineligibility were: poor clinical conditions and insufficient depth of response. Median survival for patients the underwent and did not undergo front-line ASCT and for entire cohort was 122, 37 and 68 months respectively. Multivariate analysis identified four prognostic factors that impacted on survival: ISS score, performance status, front-line ASCT and depth of response. Discussion: Increasing access to new drugs can help to achieve a better depth of response and early diagnose can prevent deterioration of clinical status that renders makes patients ineligible to ASCT, an important part of myeloma treatment. Conclusion: Improving accessibility to ASCT can ameliorate quality of life and survival in MM patients.