Refractory multiple myeloma refers to myeloma cancer that does not respond or stops responding to treatment. A doctor may recommend repeating the therapy or trying a combination of them. It’s also possible you need an entirely different treatment plan.
Initial treatment for multiple myeloma is effective for some people but may not put the condition into remission for many others. In some cases, the treatment may yield an initial positive response but then stop working. When this happens, the healthcare team may explore other therapies or a combination thereof.
Myeloma may be classified as either relapsed — if treatment initially worked but then stopped responding, or refractory — if the condition starts progressing despite initial treatment.
A doctor may use the term “primary refractory multiple myeloma” if cancer does not have at least a partial response to the initial treatment. They may refer to “double refractory multiple myeloma” if the same happens during treatment with a protease inhibitor and an immunomodulatory agent (two therapies). They may call it “triple-class refractory cancer” if monoclonal antibodies are added to the protocol and this is also not effective.
Experts are not yet clear on why some multiple myeloma diagnoses do not respond to treatment, but changes in the bone marrow and the resilience of multiple myeloma cells
Relapsed vs. refractory myeloma
Cancer that has relapsed has gone into remission and then come back. Refractory means the cancer stopped responding to treatment but never went into remission.
Remission is when the signs and symptoms of cancer are significantly reduced or disappear completely.
Read more about relapsed vs. refractory multiple myeloma.
The most common symptoms of multiple myeloma fall under the acronym CRAB, which stands for:
- Calcium elevation, which may lead to:
- Renal failure, also known as kidney failure, which can lead to:
- Anemia, known as low red blood cell count, could cause:
- fatigue
- irritability
- shortness of breath
- pale skin, especially in people with light skin
- chest pain
- headaches
- dizziness
- Bone abnormalities may lead to:
- bone pain
- bone weakness
- osteoporosis
- frequent fractures
A healthcare team will order regular tests to monitor cancer during treatment. They will also order a combination of tests to specifically look for signs of multiple myeloma.
They may perform a bone marrow aspiration and biopsy. During this procedure, a healthcare professional extracts a small section of bone marrow with a thin needle to analyze the cells in a lab.
According to a
- blood tests
- complete blood count
- immunofixation test
- serum-free light chain assays
- beta-2 microglobulin test
- lactate dehydrogenase test
- peripheral blood smear
comprehensive metabolic panel - serum electrophoresis
- urine tests
- imaging tests
If you need to change treatment strategies or incorporate new ones into the current treatment, it may be helpful to create a list of questions to ask ahead of your medical appointments.
Some questions may include:
- What are my treatment options now that the initial treatment didn’t work?
- Can we try the same treatment later on to see if things change?
- Does this mean I will need more aggressive or frequent treatment?
- Is there something I can do at home to increase my chances of the treatment working?
- Will my treatment schedule change?
- Will I need to see you or another doctor more frequently?
- How much will my treatment cost?
- What’s the outlook for refractory multiple myeloma?
- How will the new treatment affect my quality of life?
- Is the new treatment compatible with all the medications I am taking? (Especially those for treating other conditions)
- How often do we need to check if the treatment is working?
- What are the side effects of the new treatment?
- When should I contact you during this treatment?
If initial treatment is not effective, the healthcare team may recommend a new plan to improve symptoms, prevent organ damage, and treat the cancer.
If you have had a partial response for at least
Factors healthcare teams consider when recommending treatment for refractory or relapsed myeloma may include:
- age
- overall health status
- presence of other health conditions
- new symptoms you’re experiencing
- response to initial therapy
- disease progression if any
- affordability and accessibility
Read more about multiple myeloma treatments.
According to the American Cancer Society (ACS), the overall 5-year relative survival rate for a person with multiple myeloma in the United States is
However, this statistic depends on the stage of multiple myeloma at the time of diagnosis. People who receive a diagnosis early on, when multiple myeloma is localized, typically have higher chances of survival.
The outlook for a person with a refractory multiple myeloma diagnosis is generally more challenging than someone with myeloma where the cancer responds to initial treatment. However, advances in treatment mean that people with refractory multiple myeloma now have more treatment options available.
In a 2021 study reviewing data from the French National Healthcare Database, researchers found that among 12,987 people with relapsed or refractory multiple myeloma, half of the group lived at least 32.4 months after restarting treatment.
At the conclusion of a
New treatments improving outlook for multiple myeloma
According to a small 2019 study, CAR T-cell therapy that targets the B-cell maturation antigen (BCMA) showed promise in producing sustained remission in those with relapsed or refractory multiple myeloma.
About 85% of participants responded to the therapy, and 45% had a complete response (disappearance of all signs of cancer).
Myeloma is known as refractory if it does not respond to treatment or stops responding to treatment.
If you have refractory myeloma, your doctor may recommend repeating treatment with the same therapy or trying a new management option.
New therapies mean people with refractory myeloma have a higher chance of better outcomes now than they would have in the past.