Treatment for relapsed and/or refractory myeloma
The nature of myeloma means that all patients with myeloma will eventually relapse and require further treatment.
Relapsing myeloma is usually identified during routine monitoring through an increase in paraprotein and/or light chains in the blood. For many patients, the recurrence of previous myeloma-related symptoms or the emergence of new symptoms, together with a general deterioration in health, can also mark the start of a relapse – some patients reported they “just knew” they were relapsing from the way they had felt.
Watch the following clip of Prof Graham Jackson, Consultant Haematologist, talking about relapsed/refractory myeloma. He clarifies what a relapse is, how a relapse is confirmed and gives advice about the role of treatment in relapse and the questions patients should be asking at this stage.
Treatment for relapsed myeloma is based on the same principles as those used for treating newly-diagnosed patients. The treatment itself is also similar i.e. combinations consisting of one or two novel agents and/or a steroid. A chemotherapy drug may also be used in place of one novel agent, for example bortezomib, cyclophosphamide and dexamethasone (VCD) may be used instead of daratumumab, bortezomib and dexamethasone (DVD). If appropriate, patients may be offered a second HDT-SCT.
In some cases, the previous treatment can be repeated if the initial response to it was good, lasted at least 2-3 years, and the myeloma did not progress whilst on the treatment. However, because many patients develop treatment resistance, the majority of patients benefit from a different type of treatment, if available. At this stage, entry into a clinical trial may also be an option.