Skip to main content

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, 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. 

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. These include the following drug 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

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

Related Links

Download or order The Leukemia & Lymphoma Society's free booklets