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Refractory and Relapsed

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). The choice of a treatment regimen at relapse is affected by many factors including previous therapy, rate of relapse, patient health, and genetic abnormalities. 

In some instances, if the patient had a good response to a drug or combination of drugs initially, that treatment option may be repeated. Treatment can include the following drugs and combinations:

  • Bortezomib (Velcade®), lenalidomide (Revlimid®), dexamethasone
  • Carfilzomib (Kyprolis®), dexamethasone
  • Carfilzomib, lenalidomide, dexamethasone
  • Daratumumab (Darzalex®), bortezomib, dexamethasone
  • Daratumumab, lenalidomide, dexamethasone
  • Elotuzumab (Empliciti™), lenalidomide, dexamethasone
  • Ixazomib (Ninlaro®), lenalidomide, dexamethasone
  • Pomalidomide (Pomalyst®), bortezomib, dexamethasone
  • Pomalidomide, elotuzumab, dexamethasone
  • Pomalidomide, carfilzomib, dexamethasone
  • Selinexor (Xpovio®), bortezomib, dexamethasone
  • Teclistamab-cqyv (Tecvayli™) 

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 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. The most frequently targeted antigen in CAR T-cell immunotherapy for leukemia and lymphoma is called “cluster of differentiation 19” (CD19). The CD19 antigen is expressed on the surface of nearly all healthy and cancerous B cells, including lymphoma and leukemia B cells. 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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