Your first myeloma relapse can come as an unwelcome surprise, especially if your initial treatment was effective and you’ve been feeling better during remission.

As stressful as it may be, it’s not unusual for an initial treatment to stop working as well as it did at first. Many people with multiple myeloma have more than one relapse over the course of the disease. Knowing what to expect from your first myeloma relapse can help you prepare.

In this article, we’ll talk about what to expect from a first myeloma relapse. We’ll touch on the different types of myeloma relapse, how a myeloma relapse is detected, and what options your doctor may recommend for your next treatment.

Types of Multiple Myeloma Relapses

A relapse marks the end of a remission period, when multiple myeloma was responding to treatment or under control. When a multiple myeloma relapse occurs, the signs or symptoms come back despite having previously improved or gone away. A person can go through multiple cycles of remission and relapse.

In some cases, multiple myeloma relapses happen when a person becomes resistant to a treatment that had been working.

Several different types of relapse can happen for people with multiple myeloma.

Biochemical Relapse

During a biochemical myeloma relapse, your doctor detects an increase in myeloma protein (M protein) levels. However, a biochemical relapse isn’t associated with a return or increase in myeloma symptoms.

"I'm experiencing my first relapse, but I’m hopeful."
— A MyMyelomaTeam Member

Your doctor will need to monitor your M protein levels to see if your myeloma is progressing. They’ll want to start treating you right away if you have high-risk myeloma so that the relapse doesn’t progress to causing symptoms.

Clinical Relapse

Having a clinical multiple myeloma relapse means your multiple myeloma has returned with symptoms or has started causing organ damage. Your doctor may recommend starting treatment again if they determine your multiple myeloma has relapsed or is worsening.

Extramedullary Myeloma Relapse

If you have extramedullary multiple myeloma (EMD), it means you’ve developed myeloma tumors outside the bone marrow. These tumors can show up in your soft tissues (such as muscle) or in different organs.

You might have EMD from the time you’re diagnosed with myeloma, or it can appear during a relapse.

How Myeloma Relapses Are Detected

For people with a clinical relapse, symptoms are the first indication of a relapse. Others require testing to detect signs of a multiple myeloma relapse.

In some cases, a blood test can detect a myeloma relapse. Your healthcare team may use blood tests to check your M protein levels, which would help detect a biochemical relapse without symptoms.

Imaging studies can help detect and monitor relapses with extramedullary disease. Doctors use positron emission tomography (PET) or computed tomography (CT) scans to detect myeloma tumors in organs or soft tissues.

Factors Doctors Consider When Recommending Treatment

There isn’t a one-size-fits-all treatment for a first myeloma relapse. Your myeloma specialist will consider several factors about your case when making treatment recommendations for your relapse. They’ll consider:

• The medications you’ve stopped responding to
• How well you’ve responded to other treatments
• The type and aggressiveness of your relapse
• How old you are
• Other medical conditions you have
• Your overall general fitness and functional capacity
• How long your myeloma has been in a period of remission

Treatment Options Your Myeloma Specialist Might Recommend

When you’re diagnosed with a first myeloma relapse, doctors usually recommend treatments other than those used in the initial treatment regimen. Your doctor may recommend combination therapy, meaning you’d receive more than one treatment at the same time.

Your myeloma specialist will make recommendations after evaluating your myeloma relapse and overall health. They may recommend one or more of the following treatments for your first relapse.

1. Watch and Wait or Active Monitoring

If you don’t have symptoms and your myeloma isn’t progressing rapidly, your doctor may recommend a watch-and-wait approach (also called active monitoring) instead of starting treatment immediately. This involves closely monitoring your disease, usually with regular blood tests to track your M protein levels.

This approach is usually recommended for people with an indolent (slow-progressing) biochemical relapse who remain completely without symptoms and show no signs of end-organ damage.

2. Revisit Your First Treatment

Your myeloma specialist may recommend giving previous treatments another try if the relapse occurred at least one year after your initial treatment. Since some time has passed, your initial treatment may once again be effective for managing the relapse.

3. CAR T-Cell Therapy

Chimeric antigen receptor T-cell therapy (CAR T-cell therapy) involves programming T cells in your immune system to seek out and kill multiple myeloma cancer cells. Your oncology team collects a blood sample, removes T cells from it, and processes them in a lab before returning them to your system.

“I’ve been told by my oncologist that I’m in the early stages of relapse. They caught it early. I’m considering a very new treatment, just approved.”
— A MyMyelomaTeam member

A form of immunotherapy, CAR T-cell therapy isn’t the most effective option for everyone, but it can get rid of advanced cancer in some cases.

4. Bispecific Antibodies

Bispecific antibodies are immunotherapies that help your immune system’s T cells seek out and destroy cancer cells. Unlike CAR T-cell therapy, bispecific antibody therapy doesn’t involve processing your T cells in a lab. Instead, bispecific antibodies activate your T cells inside your body and are ready to use right away.

5. Chemotherapy

Your doctor may recommend chemotherapy to treat your first myeloma relapse. Chemotherapy delivers drugs into your bloodstream that target and destroy cancer cells throughout your body.

6. Bone Marrow Transplant

An autologous bone marrow transplant involves reintroducing your own healthy blood cells from your bone marrow back into your body. They help your blood replace cells that have been damaged during aggressive cancer treatments like high-dose chemotherapy.

7. Monoclonal Antibodies

Monoclonal antibodies are intravenous (IV) drugs that search for and target specific parts of myeloma cells. They boost your immune system, can improve response to treatments like chemotherapy, and can help destroy cancer cells during a myeloma relapse.

8. Proteasome Inhibitors

Proteasome inhibitors are medications that help kill cancer cells or stop them from growing so that your myeloma doesn’t progress. They work by stopping certain proteins inside the myeloma cells from breaking down. Those proteins then build up inside the cells, which overwhelms those cancer cells until they die.

9. Clinical Trials

Your doctor may recommend participating in a clinical trial at any point. Clinical trials test new treatments for myeloma or new combinations of treatments that may work just as well as or better than the current available options.

Your myeloma specialist can tell you about ongoing clinical trials that may be available to you. They’ll let you know if you’re a candidate for any clinical trials currently happening.

Make Decisions in Partnership With Your Doctor

Each time you relapse, you must review treatment options with your myeloma specialist.

Ultimately, you and your doctor will make decisions about your myeloma relapse treatment plan together. This is called shared decision-making, and it allows you to take an active role in your myeloma care.

Be sure to tell your multiple myeloma specialist about your treatment goals and preferences. You should ask your doctor questions about side effects and other concerns. Gather as much information on a treatment as possible before making decisions.

Your myeloma specialist will make recommendations based on the details of your myeloma relapse and overall health and can inform you of each treatment option’s benefits and risks. You and your myeloma specialist will then work together to make a decision on which treatments or which combination of treatments to use for your first myeloma relapse.

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