Some patients still have myeloma cells in their bone marrow after treatment. This is called refractory myeloma.
Some patients have a return of myeloma cells in the marrow and a decrease in normal blood cells after remission. This is called a relapse.
Almost all myeloma patients will experience relapse (the cancer returns after a successful course of treatment) and/or the disease will become refractory (the cancer does not respond to treatment). In some instances, the drug or combination of drugs that the patient had a good response to initially, may be repeated. Another option is to try one or more of the other therapies typically used in initial treatment. Thalomid®, once used routinely for newly diagnosed myeloma patients until the adoption of Revlimid® and Velcade®, is one of the drugs now often used for treating relapsed/refractory myeloma. This therapy is usually given in combination with either the corticosteroid dexamethasone or other drugs.
A number of different chemotherapy agents may be used in combination with dexamethasone for relapsed/refractory myeloma. Some possibilities include
- Cyclophosphamide (Cytoxan®), and doxorubicin hydrochloride (Adriamycin®)
- Cisplatin (Platinol®), doxorubicin hydrochloride, cyclophosphamide, etoposide (Toposar®, VePesid®), plus thalidomide (Thalomid)
- Cyclophosphamide, etoposide, cisplatin.
Treatments with novel agents include
- Panobinostat (Farydak®) in combination with bortezomib and dexamethasone
- The proteasome inhibitor bortezomib (Velcade), plus liposomal doxorubicin (Doxil®)
- Velcade as a single agent or in combination with dexamethasone
- The immunomodulatory agent lenalidomide (Revlimid) plus dexamethasone
- The proteasome inhibitor carfilzomib (Krypolis™)
- The immunomodulatory agent pomalidomide (Pomalyst®).
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 not been treated with a transplant before or who had a good durable response to a prior transplant.
Many new agents being studied in clinical trials are also showing promising results in the treatment of relapsed/refractory myeloma. See Clinical Trials.
For information about the drugs mentioned on this page, visit Drug Listings.