Refractory and Relapsed
Some patients still have myeloma cells in their bone marrow after treatment. This is called refractory myeloma. If you have refractory myeloma, your treatment options include using drugs not used during your past treatment to induce remission or an autologous stem cell transplantation to try to produce a longer remission
If your myeloma returns after a remission, you've relapsed. You'll need more chemotherapy with the same or different drugs used earlier during treatment or an autologous stem cell transplantation if you're a candidate for one.
Treatments with novel agents for relapsed/refractory myeloma include
- Carfilzomib (KyprolisTM), FDA approved to treat patients with multiple myeloma (MM) who have received at least two prior therapies, including treatment with Velcade® (bortezomib) and an immunomodulatory therapy.
Kyprolis, administered intravenously (IV), was evaluated in a study of 266 patients with relapsed MM who had received at least two prior therapies, including Velcade and Thalomid® (thalidomide).
The study was designed to measure the percentage of patients who experienced complete or partial disappearance of tumor after treatment (overall response rate). The overall response rate was 23 percent. The median duration of response was 7.8 months.
- Pomalidomide (Pomalyst®), given by mouth, is FDA approved to treat people with multiple myeloma who have received at least two prior therapies including Revlimid and Velcade and have demonstrated disease progression on or within 60 days of completion of the last therapy.
- The proteasome inhibitor bortezomib (Velcade®), plus liposomal doxorubicin
- Velcade as a single agent or in combination with dexamethasone
- The immunomodulatory agent lenalidomide (Revlimid®), plus dexamethasone
A number of different chemotherapy agents may be used in combination with
dexamethasone for relapsed/refractory myeloma. Some possibilities include
- Cyclophosphamide (Cytoxan®), vincristine (Oncovin®) and doxorubicin
- High-dose cyclophosphamide
- Cisplatin (Platinol®), doxorubicin hydrochloride, cyclophosphamide, etoposide
(Toposar®, VePesid®), plus thalidomide (Thalomid®)
- Cyclophosphamide, etoposide, cisplatin.
If you would like to read about these drugs individually, including information about side effects, click here.