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Relapsed Multiple Myeloma: Options After Multiple Treatments

Relapsed Multiple Myeloma: Options After Multiple Treatments

This article is for people who have relapsed multiple myeloma and their caregivers, or anyone who wants to learn more about relapsed multiple myeloma. The goal of this patient education activity is to help patients and caregivers engage in shared decision-making with their doctors about treatment for relapsed multiple myeloma.

You will learn about:

  • Treating relapsed multiple myeloma

  • Treatment options for relapsed multiple myeloma after multiple treatments

  • Potential side effects from treatment

  • Managing side effects

  • Questions to ask your doctor

All medicines listed in this activity are not FDA approved for relapsed multiple myeloma but are recommended by the National Comprehensive Cancer Network (NCCN).

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What Is Relapsed Multiple Myeloma?

Myeloma is cancer that starts in white blood cells -- called plasma cells -- in your bone marrow where they're made. When myeloma cells grow and spread throughout the bone marrow, it's called multiple myeloma.

If your tests no longer show signs of cancer after treatment, you're in remission. But most people with multiple myeloma can eventually relapse. Relapsed (or recurrent) multiple myeloma means cancer has come back after treatment and remission. Multiple myeloma can relapse once or a few times.

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Treating Relapsed Multiple Myeloma

There are treatments for relapsed multiple myeloma. The goals are to decrease the number of cancer cells, stop cancer from spreading, and help you feel better.

Your doctor may recommend a combination of different medicines. Some are used after 2 to 5 prior treatments (or combination of treatments) have been used.

Which treatment your doctor recommends will depend on how long you were in remission, your overall health, other conditions you have, what treatment you had before, and your wishes and preferences.

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Types of Treatment

Types of treatment your doctor may recommend can include:

  • Medicines such as:

    Chemotherapy (or "chemo") to kill cancer cells

    Targeted therapy to destroy cancer cells, stop them from growing, or help other treatment -- such as chemotherapy -- work better

    Steroids to decrease swelling and kill cancer cells, either alone or with chemotherapy, targeted therapy, or both

  • Stem cell transplant to replace damaged or destroyed blood stem cells (cells that develop into mature blood cells) in the bone marrow

  • Joining a clinical trial

  • Supportive care to ease your symptoms or treatment side effects and improve your quality of life

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Medicines Used After Prior Treatment

Medicines your doctor may recommend after you've had prior treatment may include:

  • Chemotherapy, such as cyclophosphamide, doxorubicin, etoposide, cisplatin, or bendamustine

  • Targeted therapy, such as:

    Proteasome inhibitors bortezomib, carfilzomib, or ixazomib

    Immunomodulators lenalidomide, pomalidomide, or thalidomide

    Monoclonal antibodies daratumumab, elotuzumab, or isatuximab

    Antibody-drug conjugate (a monoclonal antibody linked to a chemotherapy medicine) belantamab mafodotin

    Histone deacetylase inhibitor panobinostat

    Selective inhibitor of nuclear export selinexor

    BCL2 inhibitor venetoclax

  • Steroids such as dexamethasone or prednisone

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Treatment Side Effects

All medicines can have side effects. Talk with your doctor before treatment about when you should call your doctor or go to the emergency room because of side effects.

Some side effects can go away on their own over time, but others may last longer and can be managed. During treatment, your doctor will do tests to check how well treatment is working and the health of your bones, kidneys, and other organs. They will also check on side effects.

Not all side effects are listed in this activity. Ask your doctor, healthcare team, or pharmacist for a complete list.

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Side Effects From Chemotherapy or Steroids

Side effects that may happen with chemotherapy include:

  • Fatigue (tiredness, weakness)

  • Nausea and vomiting 

  • Diarrhea

  • Bruising or bleeding

  • Hair loss

  • Infections

  • Loss of appetite or weight

  • Mouth sores

  • Decreases in certain blood cell levels

Side effects that may happen with steroids include:

  • Nausea

  • Increased appetite and weight gain

  • Mood changes and sleep problems

  • Weak bones (osteoporosis)

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Side Effects From Targeted Therapy

Side effects that may happen with targeted therapy can include:

  • Fatigue (tiredness, weakness) 

  • Nausea and/or vomiting 

  • Diarrhea or constipation  

  • Decreases in certain blood cell levels  

  • Numbness or tingling in the hands or feet (with certain medicines)

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Additional Side Effects From Targeted Therapy

Monoclonal antibodies may also cause back pain or fever. Some people may also have a side effect when they get these medicines as an infusion into a vein. This infusion reaction can cause symptoms like dizziness or throat tightness, trouble breathing, wheezing, or coughing.

If you have problems with your eyes during treatment with belantamab mafodotin-- such as vision changes or loss, blurriness, or dry eyes -- be sure to tell your doctor.

The medicine selinexor may also cause fever, weight loss, or infections in your upper respiratory tract (nose, mouth, and throat).

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Managing Side Effects

Your doctor may recommend changing treatment or adding a medicine before, during, or after treatment to help with side effects. Nausea and vomiting and reactions from infusions can be helped by taking medicine before treatment.

Ask your doctor before you start treatment about side effects that can happen. And be sure tell them about any side effects you have during treatment and how they affect your daily life. Together, you can discuss ways to manage them.

You can record your symptoms and side effects in a journal or diary. This can be especially helpful when talking to your doctor.

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Questions to Ask Your Doctor

Questions you can ask your doctor can include:

  • What treatments are available, and what are their side effects?

  • What are the goals of treatment?

  • What's the best way to manage treatment side effects?

  • How will we know if treatment is working?

  • How can I make sure I have the best quality of life possible?

  • Are there any lifestyle changes I should make?

  • What should I do if I feel stressed or depressed?

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You have successfully completed the program Relapsed Multiple Myeloma: Options After Multiple Treatments.

View Additional Materials View Additional Materials on this topic that you may find useful

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Authors and Disclosures

Clinician Reviewer

Susan L. Smith, MN, PhD

Senior Director, Learning & Development, Medscape, LLC

Disclosure: Susan L. Smith, MN, PhD, has disclosed no relevant financial relationships.


Anita A. Galdieri, PharmD, RPh

Senior Scientific Content Manager, Medscape, LLC

Disclosure: Anita A. Galdieri, PharmD, RPh, has disclosed no relevant financial relationships.


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