Treatment for relapsed myeloma

• Myeloma usually follows a relapsing-remitting pattern and it may come back several times.
• There are lots of treatments available to treat relapsed myeloma.
• Your options will depend on how many times the myeloma has relapsed, and which drugs you’ve had before.
• You may be able to join a clinical trial and try a new drug or combination of drugs that isn’t available as standard.

There are lots of treatments available for people whose myeloma has relapsed, even if it comes back several times. There may also be a suitable clinical trial that you could take part in.

You will likely have a combination of drugs over several weeks or months. These are the treatments currently approved in the UK for myeloma that has relapsed:

The main treatments if you have already had at least one treatment for myeloma are:

• daratumumab, bortezomib and dexamethasone
• lenalidomide and dexamethasone
• carfilzomib and dexamethasone
• carfilzomib, lenalidomide and dexamethasone
• bortezomib and dexamethasone
• selinexor, bortezomib and dexamethasone
• belantamab mafodotin, bortezomib and dexamethasone
• belantamab mafodotin, pomalidomide and dexamethasone (in England and Wales)
• pomalidomide, bortezomib and dexamethasone (in Scotland)
• pomalidomide and dexamethasone (in Scotland).

A small number of people have a second stem cell transplant, instead of drugs, when they relapse.

This will only be suitable if you were in remission for at least 18-24 months, without maintenance treatment, after your transplant. You will also need to still be fit and well enough for the procedure.

A second stem cell transplant is not very common, as there are now other good treatment options. Also, the remission after a second transplant is usually shorter than after the first one. This means that a drug combination will usually have better results than a second transplant.

You may be offered one of these treatments if you have already had at least two treatments for myeloma:

• ixazomib, lenalidomide and dexamethasone (in England, Wales and Northern Ireland)
• panobinostat, bortezomib and dexamethasone
• pomalidomide, bortezomib and dexamethasone (in Scotland)
• pomalidomide and dexamethasone (in Scotland)
• selinexor, bortezomib and dexamethasone.

You may be offered one of these treatments if you have already had at least three treatments for myeloma:

• daratumumab on its own
• ixazomib, lenalidomide and dexamethasone (in England, Wales and Northern Ireland)
• isatuximab, pomalidomide and dexamethasone
• panobinostat, bortezomib and dexamethasone
• pomalidomide and dexamethasone
• selinexor, bortezomib and dexamethasone (in Scotland)
• talquetamab (in England, Wales and Northern Ireland)
• teclistamab
• elranatamab.

You may be offered one of these treatments if you have already had at least four treatments for myeloma:

• pomalidomide and dexamethasone
• panobinostat, bortezomib and dexamethasone
• selinexor and dexamethasone
• selinexor, bortezomib and dexamethasone (in Scotland)
• talquetamab (in England, Wales and Northern Ireland)
• teclistamab
• elranatamab.

This will depend on the treatment you are having. You can take some drugs at home, while others are given at a hospital.

To find out how a particular drug is taken, see our A to Z of myeloma drugs.

Your doctor will consider several things when deciding which treatments to recommend:

• Previous treatments – the treatments you’ve already had can affect your future treatment options.
• Your response to previous treatment – your doctor will look at how long you stayed in remission and any severe side effects.
• Your general health and fitness – this includes whether you have any other conditions such as heart problems.
• Problems caused by the myeloma – for example, if the myeloma is causing problems with your bones or kidneys.
• Genetic test results – information about gene changes in your myeloma cells may help to identify the best treatment for you.
• Practical reasons and preferences – they will consider your own situation and feelings. For example, if regular hospital appointments would be a struggle.

Sometimes, myeloma stops responding to treatment. This is called refractory myeloma.

If this happens, your consultant might suggest you take part in a clinical trial. This could give you the chance to try a new treatment or drug combination.

If you don’t want to take part in a trial, your consultant will discuss other treatment options with you. These will be based on which drugs you’ve already tried, your general health and your wishes.

When there are no more lines of treatment

There are many lines of treatment for myeloma and more are being researched. But you might reach a stage where you have tried everything or choose not to have further myeloma treatment.

If this happens, your doctor will discuss what’s likely to happen (your prognosis) with you. You will still have treatment for any symptoms, such as anaemia, infections or bone pain. You may hear this called palliative care. The aim is to help you live as comfortably as possible.

It’s very important to talk through your options with your hospital team. You can also contact our free Support Service for support to have this conversation.

This information has been accredited with the PIF TICK, the UK's only quality mark for trusted health information.

Last full review May 2026. Next full review due May 2029. We may make factual updates between reviews.

Thank you to Consultant Haematologist Dr Emma Searle and Clinical Nurse Specialist Amie Martin for checking the clinical accuracy of our myeloma information. Thanks also to Cecelia, Craig, Joan, Kaleigh, Kerry, Louise, Mart, Sandra, Scott for supporting this project and sharing their experience of living with myeloma.