Treatment for relapsed myeloma

What does ‘relapse-remitting’ mean?

Myeloma is a relapsing-remitting cancer, which sets it apart from many other cancers. ‘Relapsing-remitting’ means there are periods when the myeloma is active and causing problems in the body and needs to be treated. Treatment aims to bring the myeloma back under control and provide a period of remission or plateau (where the myeloma is under control at a steady level).

After reaching remission or plateau, many patients will remain well for some time – it may be months or years before the myeloma becomes active again. However, at some point after a period of treatment and plateau or remission, the myeloma will become active again and further treatment is required. This is called a relapse.

Patients are monitored regularly to ensure that a relapse is detected as early as possible. Relapses can happen several times during the course of the disease. This can be worrying, but there are treatment options at relapse.

How will I know if I’m relapsing?

Your doctor will monitor you using blood tests and use the results to pick up when you’re relapsing. They’ll look at trends in your results, rather than at individual results, to determine whether your myeloma is progressing.

You might also experience some myeloma symptoms again, so make sure you tell your doctor about anything you notice, like pain or fatigue.

What is the treatment for relapsed myeloma?

There are different treatment options available at each relapse and there’s no ‘one size fits all’.

The treatment you’ll have will depend on your individual circumstances, including the number of relapses you’ve had, what you’ve been treated with before and what’s available through the NHS where you live. Your doctor will also look at your previous responses to treatment and how well you’re likely to cope with any potential side effects.

You and your doctor will discuss your options and decide what’s right for you together.

Commonly used treatments for relapse

There are many effective treatment options for relapsed myeloma.

More information about these treatments, including how they work, how they are given and potential side effects, can be downloaded from the bottom of this page.

You can also find out more in our webinar ‘Treatment strategies for relapsing and refractory myeloma’.

What will be available to you will depend on your individual circumstances, but you can use the lists below to give you an idea of what may be available for use.

You can find out how these treatments become available in our Health Technology Assessment Infosheet.

First relapse – second line

• Bortezomib (Velcade®)
• Bortezomib (Velcade®), cyclophosphamide/thalidomide and dexamethasone
• Carfilzomib (Kyprolis®) and dexamethasone
• Carfilzomib (Kyprolis®), lenalidomide (Revlimid®) and dexamethasone
• Daratumumab (Darzalex®), bortezomib (Velcade®) and dexamethasone
• A second high-dose therapy and autologous stem cell transplant
• Very rarely, an allogeneic (donor) stem cell transplant

Second relapse – third line

• Ixazomib (Ninlaro®), lenalidomide (Revlimid®) and dexamethasone
• Lenalidomide (Revlimid®) and dexamethasone
• Panobinostat (Farydak®), bortezomib (Velcade®) and dexamethasone

Third relapse – fourth line

• Daratumumab (Darzalex®)
• Isatuximab (Sarclisa®), pomalidomide (Imnovid®) and dexamethasone
• Ixazomib (Ninlaro®), lenalidomide (Revlimid®) and dexamethasone
• Lenalidomide (Revlimid®) and dexamethasone
• Panobinostat (Farydak®), bortezomib (Velcade®) and dexamethasone
• Pomalidomide (Imnovid®) and dexamethasone

Fourth relapse and beyond – fifth line +

• Lenalidomide (Revlimid®) and dexamethasone
• Panobinostat (Farydak®), bortezomib (Velcade®) and dexamethasone
• Pomalidomide (Imnovid®) and dexamethasone
• DT-PACE
• Drugs available through compassionate use or expanded access schemes – selinexor (Nexpovio®), belantamab mafodotin (Blenrep®)

You may also be able to access a different combination at each relapse via a clinical trial – Find out more about clinical trials.

Coping with a myeloma relapse

Learning that your myeloma has relapsed can be difficult and an emotional time. Your doctor and nurse are there to support you and our Myeloma Information Specialists are only a call or email away. You may like to read our Infopack for relapsed and/or refractory patients to help you prepare for this time.

Hearing from other patients can help too. You can talk to others at a Support Group, on our Discussion Forum or through our Peer Buddy service.

Find out how myeloma patient Martyn learnt to cope with his own myeloma relapse:

Will I run out of treatment options?

It’s important to remember that there are many different treatment options for myeloma and your healthcare team will advise you on your options at each relapse.

Unfortunately, however, there can come a time when myeloma progresses to a point where nothing more can be done to keep it under control. At this point your treatment will be to manage your symptoms to ensure the best quality of life. Find out more about the end of treatment and how to plan ahead for this time on our Planning ahead page.