Key Takeaways

  • When multiple myeloma returns after a period of remission, treatment plans often need to be adjusted because the cancer may have become resistant to previous medications.
  • Doctors determine the most suitable new treatment options by considering factors like your age, overall health, the specific characteristics of your cancer, and any prior treatments you’ve received.
  • A variety of treatment approaches are available for relapsed multiple myeloma, including different drug combinations, stem cell transplants, and newer therapies like T-cell engagers and CAR T-cell therapy.

Multiple myeloma is a relapsed-refractory cancer type. After initial treatment, many people go into remission, meaning there is no sign of disease in the body.

Periods of remission can vary in length and depend on many factors. If the myeloma returns, however, treatment may not be the same as the first time around, as the disease can become resistant to medications.

In these cases, your healthcare team may recommend switching to a different or more effective treatment approach.

If a doctor confirms that you’re in remission from multiple myeloma, it means your body has shown no signs of the disease for at least 60 days after completing treatment. If the disease returns, this is called a relapse.

A relapse can feel discouraging, but your healthcare team can help guide you through treatment options tailored to your overall health and specific needs.

It’s also possible to experience more than one period of remission and relapse over time.

Myeloma can develop resistance to certain medications, making them less effective. Drug resistance is one of the main causes of multiple myeloma relapse, and it can occur for many reasons, including:

  • too many different cancer cell types
  • the body produces too much of a specific protein that removes toxins (including medications) from the body
  • changes to proteins that affect how well the drugs bind to them
  • cancer cells avoiding being destroyed
  • increased DNA repair

In multiple myeloma, treatments and supportive medications can sometimes add stress to organs, such as the kidneys, liver, nerves, or heart. If organ damage occurs, doctors may need to adjust dosages or change medications to protect the body.

Your healthcare team will monitor your progress with tests and use the results to detect a relapse.

When you relapse, the next treatment plan may depend on the following:

  • how long you have been in remission
  • what medications you were given before, and how effective they were
  • your overall health status
  • how you would like to proceed

Your doctor will discuss your test results, treatment options, and side effects.

Tests that will help determine your next course of treatment may include blood and urine tests, magnetic resonance imaging (MRI) and positron-emission tomography (PET) scans, and genetic testing.

People newly diagnosed with multiple myeloma are usually treated with a combination of medications. This approach, often called induction therapy, is designed to stimulate a response to treatment. The specific combination of medications used will depend on your individual circumstances.

Typically, treatment will include three or four medications, and the most common combinations for active myeloma may include:

  • daratumumab (Darzalex), bortezomib (Velcade), lenalidomide (Revlimid), and dexamethasone (a type of corticosteroid)
  • bortezomib (Velcade), lenalidomide (Revlimid), and dexamethasone
  • carfilzomib (Kyprolis), lenalidomide (Revlimid), and dexamethasone

You may also have a stem cell transplant, but this will depend on how healthy you are and the severity of the disease.

If you experience a relapse, a doctor may recommend other types of myeloma medications. This could be other medication combinations or a stem cell transplant.

Newer treatment options include T-cell engagers (TCEs) and CAR T-cell therapy. Although healthcare professionals typically use these options later in the course of treatment, they’re increasingly exploring their use earlier.

There are often side effects with cancer medications, and this may be true when starting or switching treatments.

Here are some reported side effects associated with some of the most common multiple myeloma medications.

  • upper respiratory infection and difficulty breathing
  • low neutrophil levels (neutropenia)
  • infusion-related reactions
  • platelet deficiency (thrombocytopenia)
  • diarrhea or constipation
  • anemia
  • prickly, tingly, or numb sensations
  • fatigue or weakness
  • swelling in the lower legs or hands
  • nausea
  • cough
  • high temperature
  • nausea or vomiting
  • diarrhea or constipation
  • platelet deficiency (thrombocytopenia)
  • low neutrophil levels (neutropenia)
  • peripheral neuropathy
  • fatigue
  • nerve pain (neuralgia)
  • anemia
  • low white blood cell levels (leukopenia)
  • low lymphocyte levels (lymphopenia)
  • rash
  • high temperature
  • anorexia
  • diarrhea or constipation
  • fatigue or weakness
  • anemia
  • low neutrophil levels (neutropenia)
  • leukopenia
  • swelling in the lower legs or hands
  • insomnia
  • muscle cramps/spasms
  • abdominal or back pain
  • nausea
  • high temperature
  • upper respiratory tract infection, cough, bronchitis
  • common cold
  • difficulty breathing
  • gastroenteritis
  • rash
  • dizziness
  • decreased appetite
  • platelet deficiency (thrombocytopenia)
  • tremor

Carfilzomib (Kyprolis)(when used as combination therapy)

  • anemia
  • diarrhea
  • fatigue
  • hypertension
  • pyrexia
  • upper respiratory tract infection and difficulty breathing
  • platelet deficiency (thrombocytopenia)
  • cough
  • insomnia

When transitioning or continuing treatment, your healthcare team can help you understand your options and decide on your next steps.

The team can provide easy-to-understand information, advocate for your care preferences, help identify and manage treatment side effects, help you navigate insurance, and much more.

The following may be able to offer additional information and support:

Talk therapies, such as psychotherapy, with someone specializing in life-limiting conditions, may help you and your family work through the natural thoughts and feelings surrounding a cancer diagnosis and treatment.

Questions to ask your care team about switching treatment

  • What treatments are available to me?
  • What makes the treatment a good choice for my diagnosis?
  • What are the likely and possible side effects?
  • What are the risks and benefits of treatment?
  • How long do you expect each treatment to prolong my life?
  • What is my life expectancy, both with and without treatment?
  • Is there anything I can do to reduce side effects?
  • Am I eligible for any current clinical trials?

A multiple myeloma relapse doesn’t mean treatment options are exhausted. There are many possible options, and the ones you’re offered will depend on factors such as your age, overall health, and cancer stage.

Changing medication combinations may prove effective during a relapse, but other treatment options may also be available.

Your healthcare team, various support groups, and online resources can help you understand your options and feel prepared for the next chapter of condition management.