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Understanding Life Expectancy With Relapsed/Refractory Myeloma

Medically reviewed by Patrina Conley-Brown, D.O.
Written by Emily Wagner, M.S.
Posted on August 1, 2023

  • Factors that influence life expectancy with relapsed/refractory multiple myeloma (RRMM) include your age, your overall health, and details about your cancer.
  • Survival rates are improving as new treatment options for RRMM become available.
  • You can improve your outlook and quality of life by sticking to your myeloma treatment plan and taking care of your overall health, including getting regular exercise.

If you’ve been diagnosed with relapsed/refractory multiple myeloma, you’re likely wondering what your future holds. It can be scary and overwhelming to hear your cancer has returned or isn’t responding to treatment, but you and your oncologist will work together to determine your next steps forward. There are more treatment options available now than ever before.

This article will cover how RRMM affects your life expectancy and what other factors may play a role. We’ll also cover what you can do to potentially improve your prognosis or outlook and stay as healthy as possible living with RRMM.

What Is Relapsed/Refractory Myeloma?

Multiple myeloma is a type of blood cancer that affects your white blood cells. Specifically, it causes your plasma cells — the cells responsible for making immune system proteins known as antibodies — to grow out of control. Plasma cells grow in the bone marrow (spongy tissue in your bones). When plasma cells grow too fast, they stop your bone marrow from making new, healthy blood cells.

Once you’re diagnosed with myeloma, your oncologist will create a treatment plan for you. Most treatment plans involve a combination of:

  • Chemotherapy drugs
  • Immunomodulatory imide drugs (IMiDs)
  • Proteasome inhibitors
  • Corticosteroids

One example of this treatment regimen is bortezomib (Velcade), lenalidomide (Revlimid), and dexamethasone. Your oncologist may substitute thalidomide (Thalomid) for lenalidomide. The goal of combination treatment is to kill off as many myeloma cells as possible.

Over 90 percent of people respond well to their first round of myeloma treatment. On average, people are disease-free (in remission) for about four years after their first treatment. Eventually, most people relapse and see their myeloma return. However, one study found that 16 percent of people developed relapsed myeloma within one year of starting treatment. If the disease returns, new therapies are considered.

“Refractory myeloma” is the term for when cancer doesn’t respond to treatment, or it starts progressing within two months of your last treatment. Your oncologist will have you try different treatment options to find one that works best for your cancer. If you respond initially to one treatment and then your myeloma returns and is resistant to other treatments, you’ll be diagnosed with relapsed/refractory multiple myeloma.

What Does Research Show About Life Expectancy for RRMM?

When talking about life expectancy for a certain type of cancer, doctors and researchers use the term “median overall survival.” If researchers were studying a group of people with cancer who had all been diagnosed at the same time (or started a certain treatment at the same time), median overall survival is the length of time after which half of the people in the group are still alive. Noting this time can help researchers better understand which treatments are helpful.

Many studies have reported different life expectancies and survival rates for people with RRMM. One study of nearly 13,000 people with RRMM found that the median overall survival after starting the second round of treatment was 32.4 months. This means half of the people in the study lived longer than 32.4 months.

Recent advances in treatment have helped people with RRMM live longer than before. One study found that bortezomib and lenalidomide given in combination with dexamethasone add an additional 1.7 years of life expectancy for those with RRMM. The same study showed newer treatments like the monoclonal antibody drugs daratumumab (Darzalex) and elotuzumab (Empliciti) have increased life expectancy by 2.5 years.

What Affects Life Expectancy and Prognosis With RRMM?

Several factors can affect your life expectancy with RRMM. Some of these are within your control, while others aren’t. Here, we’ll discuss how the different characteristics of myeloma, your age, and your overall health play a role in your prognosis (or outlook) with RRMM.

Time Until Relapse

Researchers have found that the time it takes for your cancer to return after treatment affects your prognosis. The sooner myeloma relapses after treatment, the worse your outlook is. On the other hand, the longer it takes for myeloma to return, the better your outlook is.

One study of 511 people with myeloma found that those whose myeloma returned within one year of starting treatment (early relapse) had a median overall survival of 21 months. This means that half of the people with early relapsed myeloma lived for more than 21 months.

On the other hand, people whose cancer returned more than one year after treatment or those who were still responding to treatment (known as late relapse) didn’t reach a median overall survival after 10 years. This means that more than half of people in the study with late relapse were still alive after 10 years.

Cytogenetic Testing Results

The specific gene changes in your myeloma cells can affect your life expectancy and outlook. Known as high-risk cytogenetic features, these changes impact how well your RRMM responds to certain therapies.

A few studies have found that people with RRMM and these high-risk features tend to have shorter median overall survival. This is because certain mutations make your cancer more resistant to treatment. Your oncologist may test for these features and use them to create your treatment plan.

Age and Underlying Health Conditions

Myeloma is a cancer that tends to affect older adults — the average age at diagnosis is 70 years. Researchers have looked at how age and the greater likelihood of having underlying health conditions can affect your outlook with RRMM. Studies have found that people who are older and have more health conditions tend to have a worse myeloma treatment outlook.

Race, Ethnicity, and Life Expectancy

Race and ethnicity can also be factors that affect prognosis. Although survival has improved for people with multiple myeloma overall, survival rates for Black people with myeloma in the U.S. have improved far less significantly compared with survival rates for white people. Researchers have found that this is likely due to less access to treatment. Black and Hispanic people are less likely to have bone marrow transplants than white people. They’re also extremely underrepresented in clinical trials studying new treatments for multiple myeloma, compared with white and Asian people.

When everyone has equal access to care, Black and Hispanic have similar or better survival rates than white people. To make sure you get access to the most effective treatment options for you, stay engaged with your health care team. Don’t hesitate to ask questions, and make sure your oncology team understands your goals for treatment.

Improving Your Outlook With RRMM

While some factors are out of your control, you can take steps to improve your quality of life and outlook living with RRMM. Be sure to stick closely to your cancer treatment plan. Your oncologist will go over the best treatment options for you, depending on your overall health, previous treatments, and test results.

Treatment options for RRMM include:

  • Immunotherapy with chimeric antigen receptor T-cell therapy (CAR T-cell therapy)
  • Proteasome inhibitors like carfilzomib (Kyprolis) and ixazomib (Ninlaro)
  • IMiDs like pomalidomide (Pomalyst)
  • Bispecific T-cell engagers like teclistamab-cqyv (Tecvayli), which was approved by the U.S. Food and Drug Administration (FDA) in 2022, and talquetamab, which is currently being studied in clinical trials

It’s important to take care of your body while living with RRMM and going through intense cancer treatments. Studies have found people with myeloma tend to have a lower health-related quality of life compared to people with most other types of cancer. Many people get tired easily or have trouble breathing or chronic pain, which can make it hard to be active. Talk to your oncologist about whether adding some light exercise to your routine would be helpful for you. They can make recommendations for activities that are best for your overall health.

Talk With Others Who Understand

MyMyelomaTeam is the social network for people with multiple myeloma and their loved ones. On MyMyelomaTeam, more than 20,000 members come together to ask questions, give advice, and share their stories with others who understand life with myeloma.

Do you have more questions about life expectancy with relapsed/refractory myeloma? Share your thoughts in the comments below, or start a conversation by posting on your Activities page.

References
  1. What Is Multiple Myeloma? — American Cancer Society
  2. Multiple Myeloma: Initial Treatment — UpToDate
  3. Frontline Myeloma Treatment Options — International Myeloma Foundation
  4. The Future Looks Bright — Including a Cure for Myeloma — International Myeloma Foundation
  5. Treatment Outcomes — Leukemia & Lymphoma Society
  6. Relapsed/Refractory Multiple Myeloma in 2020/2021 and Beyond — Cancers
  7. Early Relapse Following Initial Therapy for Multiple Myeloma Predicts Poor Outcomes in the Era of Novel Agents — Leukemia
  8. Relapsed/Refractory Multiple Myeloma: A Review of Available Therapies and Clinical Scenarios Encountered in Myeloma Relapse — Current Oncology
  9. Median Survival — National Cancer Institute
  10. Survival and Treatment Patterns of Patients With Relapsed or Refractory Multiple Myeloma in France — A Cohort Study Using the French National Healthcare Database (SNDS) — Annals of Hematology
  11. The Value of Survival Gains From Therapeutic Innovations for US Patients With Relapsed/Refractory Multiple Myeloma — Therapeutic Advances in Hematology
  12. Multiple Myeloma With High-Risk Cytogenetics and Its Treatment Approach — International Journal of Hematology
  13. Cytogenetics and Long-Term Survival of Patients With Refractory or Relapsed and Refractory Multiple Myeloma Treated With Pomalidomide and Low-Dose Dexamethasone — Haematologica
  14. Frailty in Relapsed/Refractory Multiple Myeloma Registration Trials — Journal of Clinical Oncology
  15. Clinical Impact of Frailty on Treatment Outcomes of Elderly Patients With Relapsed and/or Refractory Multiple Myeloma Treated With Lenalidomide Plus Dexamethasone — International Journal of Hematology
  16. Culturally Responsive Care Delivery in Oncology: The Example of Multiple Myeloma — Clinical Lymphoma, Myeloma & Leukemia
  17. An Individualized Exercise Intervention for People With Multiple Myeloma—Study Protocol of a Randomized Waitlist-Controlled Trial — Current Oncology
  18. Lifestyle Considerations in Multiple Myeloma — Blood Cancer Journal
    Posted on August 1, 2023
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    Patrina Conley-Brown, D.O. holds a Bachelor of Science from Vanderbilt University, a Master of Science from the University of South Florida, and a Doctor of Osteopathic Medicine from Nova Southeastern University. Learn more about her here.
    Emily Wagner, M.S. holds a Master of Science in biomedical sciences with a focus in pharmacology. She is passionate about immunology, cancer biology, and molecular biology. Learn more about her here.

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