Some patients with myeloma have refractory disease. Refractory myeloma is cancer that does not respond to treatment. After a time, almost all myeloma patients will experience relapse, which means the cancer returns after a successful course of treatment. The treatment for relapsed and refractory myeloma is affected by many factors including previous therapy, rate of relapse, patient health, and genetic abnormalities.
Treatment for Relapsed and Refractory Myeloma
Treatment for relapsed or refractory myeloma may include:
- A clinical trial
- Medications that have been used before
- New medications
- Bispecific antibodies
- Autologous stem cell transplantation
- Chimeric antigen receptor (CAR) T-cell therapy
In some instances, if the patient had a good response to a drug or combination of drugs initially, that treatment option may be repeated. Trying one or more of the other therapies that are typically used in initial treatment is another option. Treatment can include the following drugs and combinations:
- KPd: carfilzomib, pomalidomide, dexamethasone
- Dara-Kd: daratumumab, carfilzomib, dexamethasone
- Dara-Pd: daratumumab, pomalidomide, dexamethasone
- Elranatamab (a bispecific antibody)
- Elo-Pd: Elotuzumab, pomalidomide, dexamethasone
- Isa-Pd: Isatuximab, pomalidomide, dexamethasone
- Isa-Kd: Isatuximab, carfilzomib, dexamethasone
- Seli-Vd: Selinexor, bortezomib, dexamethasone
- Talquetamab (a bispecific antibody)
- Teclistamab (a bispecific antibody)
- Venetoclax (Used in certain cases that your doctor may discuss)
For information about the drugs listed on this page, visit Drug Listings.
Stem Cell Transplantation. The use of high-dose chemotherapy followed by autologous stem cell transplantation may also be an option for some relapsed/refractory myeloma patients, who have either not been treated with a transplant before or who had a good durable response to a prior transplant.
Chimeric Antigen Receptor (CAR) T-Cell Therapy. CAR T-cell therapy is a type of cellular immunotherapy that consists of engineering a patient’s own immune cells to first recognize and then attack cancerous cells. The T cells are genetically engineered to produce receptors on their surface called “chimeric antigen receptors” (CARs). These receptors recognize and bind to a specific target found on the cancerous cells. CAR T-cell immunotherapy for myeloma targets the B-cell maturation antigen (BCMA). BCMA is considered an ideal target because it is expressed on the surface of plasma cells but not on hematopoietic stem cells in the bone marrow.
CAR-T drugs approved for treatment of adult patients with relapsed or refractory multiple myeloma include:
- Ciltacabtagene autoleucel (Carvykti™)
- Idecabtagene vicleucel (Abecma®)
Click here to learn more about CAR T-cell therapy.
Clinical Trials. Many new agents being studied in clinical trials are also showing promising results in the treatment of relapsed/refractory myeloma. See Clinical Trials.
Receive one-on-one navigation from an LLS Clinical Trial Specialist who will personally assist you throughout the entire clinical-trial process: Click Here
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