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Myeloma treatment and side effects

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Myeloma relapsed and refractory treatment

Unfortunately, people who have myeloma will almost always experience a relapse.

Relapsed myeloma

Relapse is the term used after someone has responded well to treatment but the condition has returned later. Your doctor may suggest certain drug combinations, depending on the stage of your treatment.

Some drug combinations (marked *) are now available under interim guidelines approved for use during the coronavirus pandemic. The aim is to protect you by offering treatments that carry a lower risk of infection, or are taken by mouth (orally) instead of by injection, reducing the time you need to spend at the hospital. These interim treatment options are recommended by NICE, whose guidance is for healthcare in England, but may be (and often is) adopted in other countries of the UK too.

Ask your healthcare team if you have any questions about the drug combination you’re being given. Read our information on coronavirus and your blood cancer treatment.

Second-line therapy

Second-line therapy may involve:

  • daratumumab, bortezomib and dexamethasone
  • lenalidomide and dexamethasone
  • carfilzomib and dexamethasone
  • bortezomib and dexamethasone
  • CTD (cyclophosphamide-thalidomide-dexamethasone)
  • ixazomib, lenalidomide and dexamethasone*
  • pomalidomide and dexamethasone*
  • lenalidomide on its own.*

The combination of carfilzomib, lenalidomide and dexamethasone was also approved as second-line therapy in England, Scotland, Wales and Northern Ireland in 2021.

If you relapse following a stem cell transplant, but were previously in remission for a minimum of 12 months, then a second autologous transplant (using your own stem cells) may be an option as second-line therapy. This will not cure the myeloma, but it should hopefully lead to another stable and lengthy remission period.

Third-line therapy

Third-line therapy is typically ixazomib, lenalidomide and dexamethasone. The following treatments are alternatives:

  • bortezomib, panobinostat and dexamethasone
  • pomalidomide and dexamethasone.*

Fourth-line therapy

Daratumumab monotherapy (daratumumab taken on its own) is used as fourth line therapy for people who haven't had daratumumab as part of a previous treatment.

Isatuximab with pomalidomide and dexamethasone has also been approved as an alternative fourth-line treatment in England, Scotland, Wales and Northern Ireland.

Fifth-line therapy

Fifth-line therapy may involve:

  • pomalidomide and dexamethasone
  • panobinostat, bortezomib and dexamethasone

Other drugs combinations which may help bring people back into remission include DT-PACE (a combination of chemotherapy drugs, thalidomide and a steroid) and ESHAP (a combination of chemotherapy drugs with a steroid).

Refractory myeloma

If myeloma stops responding to treatment, this is called refractory disease. In this case your consultant might suggest you take part in a clinical trial.

Refractory myeloma can occur at any stage in myeloma, but it’s more difficult to treat if this happens in an earlier phase.

If you don’t want to take part in a trial, your consultant will help you choose the best treatment based on which drugs you’ve already tried, your general condition, and your wishes.

Bortezomib, lenalidomide and pomalidomide are all drugs which may be used in this situation, usually in combination with dexamethasone.

Myeloma research impact

Our research in myeloma has helped pioneer new treatments and improve existing ones. Read about our research impact on myeloma.

Worried about anything or have questions?

If you have any questions, worries, or just need someone to talk to, please don't hesitate to contact our Support Services Team via phone or email.

Support for you

We're here for you if you want to talk

0808 2080 888

[email protected]