Treatment Approaches for Relapsed/Refractory Multiple Myeloma

It is important to balance treatment efficacy and quality of life for patients with relapsed/refractory multiple myeloma, states Maria-Victoria Mateos, MD, PhD. While it is critical to use effective therapies, it is equally important to ask the patient about adverse events and to modify the treatment if necessary. At the moment of relapse, considering the aggressiveness of the disease, the prior lines of therapy, and the duration of response, helps guide subsequent treatment decisions, notes Mateos.

Before initiating treatment, it is important to confirm that relapse has occurred, states Jatin J. Shah, MD. Usually, there are fluctuations in the paraprotein or light-change over time. Changing the therapeutic strategy is appropriate at this point, notes Shah.

The treatment paradigm is driven by the biology of the patient’s disease, their age, and the disease stage, explains Andrew Spencer, MD. In younger patients, an aggressive approach may be warranted, whereas, in older patients, toxicities are more of a concern, he adds. In the relapsed setting, the kinetics of the disease are different.

In later relapses, notes Spencer, patients generally have developed resistance to the standard medications. In this situation, a clinical trial involving novel therapies should be considered. In eligible patients, a second autologous stem cell transplant may also be an option, he adds.