Recurrent Multiple Myeloma

Recurrent multiple myeloma is defined as myeloma that has persisted despite treatment or returned following initial treatment. With current therapy, curing patients with recurrent multiple myeloma is uncommon; recent advances incorporating new precision medicines, immunotherapy, stem cell transplantation, and maintenance therapy however have prolonged survival by several years.

Doctors are personalizing care by finding the genetic alterations within the cancer that drive its growth and use medicines that specifically counteract the cancerous effects of those genes.  In addition, these “targeted therapies” are designed to treat only the cancer cells and minimize damage to normal, healthy cells.   The ability to test a patients’ cancer for individual differences at the genetic level, and to make treatment decisions based on those differences is the hallmark of precision medicine.

There is a steadily increasing number of newer precision medicines and immunotherapies that are being used as standard treatment of patients with recurrent multiple myeloma. These newer medicines have improved outcomes significantly.  The only potentially curative treatment for multiple myeloma remains high-dose therapy followed by a stem cell transplant using donor cells (allogeneic stem cell transplant).

About This Treatment Information

The following treatment overview summarizes the standard of care and recent advances in the treatment of recurrent multiple myeloma. Optimal treatment of multiple myeloma incorporates ongoing advances in precision medicine with chemotherapy, high-dose therapy and stem cell transplant, and maintenance therapy. Participation in a clinical trial utilizing new, innovative therapies should be considered and may provide the most promising treatment for select individuals. Learn more Strategies to Improve Treatment.

Tip-Understanding Stem Cell Transplants

Standard Therapies for Multiple Myeloma

Most patients with recurrent multiple myeloma will have already been treated with chemotherapy or a stem cell transplant. The main goal of treatment for recurrent disease is to induce a complete or near complete disappearance of myeloma cells in order to prolong survival and improve symptoms.  Treatment selection depends on patient age, general medical condition, and prior therapy.

The following medicine’s are approved by the U.S. Food and Drug Administration as treatment for multiple myeloma: These medicines are typically used in combinations to attain the best results.

  • Precision Medicines
  • Darzalex® (daratumumab)
  • Farydak® (panobinostat)
  • Empliciti®  (elotuzumab)
  • IMiDs (immunomodulatory drugs)
    • Thalomid®(thalidomide)
    • Revlimid® (lenalidomide)
    • Pomalyst® (pomalidomide)
  • Proteasome inhibitors
    • Velcade®(bortezomib)
    • Kyprolis®(carfilzomib) 
    • Ninlaro® (ixazomib) 
  • Alkylating agents (chemotherapy)
    • Alkeran®(melphalan)
    • Oncovin®(vincristine)
    • Cytoxan®(cyclophosphamide)
  • Steroids (e.g., dexamethasone and prednisone)

Combinations typically consist of medicines not used as initial treatment and often combine an IMiD plus a proteasome inhibitor or precision medicine with dexamethasone.  Determining optimal combination regimens is ongoing in clinical trials.

Continue Standard Therapies for Multiple Myeloma

Standard Therapies for Multiple Myeloma
High-dose Therapy and Stem Cell Transplant for Recurrent Multiple Myeloma
Managing Complications & Side Effects of Myeloma
Strategies to Improve Treatment
References

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