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Once a doctor determines the stage of your cancer and comes up with a treatment plan, you may look forward to putting multiple myeloma behind you. There’s no cure for this type of cancer, but remission is achievable.

Of course, not everyone responds to every type of treatment. Learning that your treatment didn’t work (or that you’ve relapsed) can be frightening and discouraging.

You now have to decide the next steps in your recovery. A doctor will offer recommendations based on your individual situation.

Just because one treatment didn’t work for multiple myeloma doesn’t mean that others will fail. Doctors use your health as a basis for their initial treatment recommendations. Their guidance is also based on what they believe will work at your stage, as well as where cancer cells are located.

Many therapies are available for multiple myeloma. These different treatments are usually called “lines.” If some lines don’t work, the doctor will suggest additional lines. Most patients go through several lines of treatment as treatments stop working.

Early stages of multiple myeloma may be treated with local therapies, such as surgery or radiation therapy that help target tumors without affecting the rest of your body. Systemic treatments, such as targeted therapies may be selected if cancer cells are present in multiple areas of your body.

It’s important to know that several treatment options exist for multiple myeloma, and a doctor may suggest a combination of therapies tailored to the stage and type of cancer. These may include biological therapy (also called immunotherapy), chemotherapy, or radiation.

Immunotherapy consists of drugs that modulate your immune system to fight cancer cells, and is considered the future of multiple myeloma cancer treatment. This therapy consists of the following categories:

  • Monoclonal antibodies: These man-made antibodies may help attack proteins on the surface of multiple myeloid cells. Examples include daratumumab (Darzalex) and isatuximab (Sarclisa) for CD38 proteins, or elotuzumab (Empliciti) for SLAMF7 proteins.
  • Chimeric antigen receptor (CAR) T-cell therapy: This type of immunotherapy relies on T-cells taken from your own blood where they are then genetically modified in a lab before being placed back into your body. Due to the potential for serious side effects, this type of immunotherapy may be used as a last resort.
  • Immune checkpoint inhibitors: When used in combination with other therapies, these drugs may help treat myeloid cells, according to in-vivo studies.

Chemotherapy is a powerful treatment used to kill cancer cells. While not a first-line treatment for multiple myeloma, it may still be considered. It’s also sometimes used as a part of CAR T-cell therapy. Examples of chemo used for this type of cancer include:

  • bendamustine (Treanda)
  • cyclophosphamide (Cytoxan)
  • doxorubicin (Adriamycin)
  • etoposide (VP-16)
  • liposomal doxorubicin (Doxil)
  • melphalan

Additionally, a steroid such as prednisone may be prescribed to off-set some chemotherapy side effects while also suppressing inflammation and cancer cell growth.

Radiation uses beams of high energy to shrink malignant cells and stop the growth of cancer. Commonly used for solitary plasmacytomas, radiation therapy may also be considered in cases of bone damage or a non-response to chemotherapy.

Clinical trials or experimental drugs are another option when a prior therapy doesn’t work. These controlled research studies help discover new strategies and medications for fighting certain types of diseases. Ask a doctor for information on clinical trials.

Multiple myeloma is a blood cancer. You may be a candidate for a bone marrow transplant (also known as a stem cell transplant) when other therapies prove ineffective.

Bone marrow is a soft tissue inside your bone that creates blood-forming cells. This procedure transplants a donor’s healthy blood-forming cells into your body. Transplantation replaces your diseased cells with healthy cells, which can help you recover.

A bone marrow transplant can sometimes be risky. Make sure you understand complications associated with this procedure. You’ll want to reduce the likelihood of your body rejecting the new bone marrow. To do this, you’ll take medication before the procedure to suppress your immune system.

You’ll also remain in the hospital for weeks after the transplant. And because there’s the risk of infection, you’ll be confined to a germ-free room until your immune system recovers and strengthens.

Your doctor may suggest maintenance therapy after a bone marrow transplant. You’ll take low doses of a targeted drug for an extended period of time to keep the disease in remission.

Before deciding next steps, have an honest conversation with a doctor to discuss your outlook. Sometimes multiple myeloma doesn’t respond despite aggressive treatments. So even if you proceeded with another therapy, the disease may progress and your health decline.

If a doctor believes that treatment won’t improve your condition, you may decide to forgo putting your body through the stress of chemotherapy, radiation, or a bone marrow transplant. If so, the next step may be palliative care.

This is different from other types of therapies. Instead of treating the illness and extending your life, palliative care focuses on relieving symptoms like pain and nausea. It helps you enjoy a better quality of life.

Some drugs administered during this period are like those used to treat cancer. The end goal is to help you live in as much comfort as possible.

Keep in mind that if you choose to continue cancer treatments and extend your life, palliative care is still an option. You’ll receive medication to treat the cancer and relieve symptoms at the same time.

Palliative care may include drug therapy, nutritional guidance, physical therapy, occupational therapy, and counseling.

When multiple myeloma progresses to the point of being terminal, your doctor may recommend hospice care. This care is unique because it treats you, not the disease. The purpose is to enhance your quality of life during this time.

Hospice care can occur in a nursing home or in your own home. You won’t receive chemo or radiation to treat the cancer but you could receive them if they were primarily being used to improve your symptoms like bone pain or difficulty breathing. You may continue to receive treatment for pain or nausea.

You can still be active and energetic in the early stages of hospice care. It’s important to stay as active as possible and live life to the fullest.

Contrary to what some people believe, you don’t have to be bedridden to qualify for hospice care. Also, turning to this option doesn’t mean that you’ve given up. It’s a choice, and there’s no reason why you shouldn’t be comfortable during your final days.

Multiple myeloma can be unpredictable, but don’t let a relapse or a nonresponse to therapy discourage you. There isn’t a cure for this type of cancer, but it’s possible to live long term with the disease.

Talk to a doctor and discuss your options and, if necessary, get a second opinion. This can help you decide which steps to take next.