It’s possible to live for many years following a relapse of multiple myeloma. Your outlook depends on a number of factors, including the length of time since your last relapse and which treatments you have tried.
Multiple myeloma is a type of blood cancer that forms in plasma cells. These cells are found in spongy material inside bones called bone marrow.
Mutated plasma cells can multiply rapidly and crowd out healthy cells in the bone marrow. These include:
- white blood cells that help fight infections
- red blood cells that supply oxygen throughout your body
- plasma that helps your blood clot
There’s currently no cure for multiple myeloma. After you finish your first course of treatment, your cancer symptoms may subside. At this time, your doctor might say your cancer is in remission. But if the signs and symptoms of your cancer reappear after a period of remission, your cancer is considered relapsed.
This article will discuss the life expectancy for people with multiple myeloma after relapse.
You can live for many years after a relapse of multiple myeloma. Life expectancy depends on many factors, such as:
- your age and current health
- the length of your remission before relapse
- how many times you’ve had a relapse
- how well you responded to initial treatment
- how early your cancer was diagnosed
- the genetics of your cancer
- if you had any severe side effects to treatment
- how well you tolerate the new treatment
According to the National Cancer Institute (NCI)’s SEER database, the overall 5-year survival rate for multiple myeloma is
Keep in mind that the NCI relies on past data to estimate survival rates.
For many people with multiple myeloma, the first period of remission can last two to three years — sometimes longer.
In general, the earlier the relapse, the worse the outlook. As time goes on, the cancer also changes and becomes more complex. Each subsequent relapse can be more difficult to treat.
In the same 2016 study, the median overall survival in patients who received a stem cell transplant and relapsed within 12 months was 23.1 months, compared to 122.2 months in those who relapsed after 12 months.
A relapse is also known as a recurrence. Generally, it means that the signs and symptoms of your cancer have returned after a period of improvement.
Once you enter remission, your doctor will monitor your blood work regularly to check for signs of a relapse.
Your doctor will determine whether you’ve relapsed using the results of blood tests and imaging, as well as a physical exam and an evaluation of your symptoms.
You may not always experience symptoms if you have a relapse. If you do have symptoms, they may include:
- bone pain
- poor kidney function
- high calcium levels
- increased risk of bleeding
These symptoms may be more severe than when the cancer was first diagnosed.
To officially diagnose a relapse, doctors will rely on the results of several imaging, urine, and blood tests to see whether you meet the criteria from the International Myeloma Working Group.
According to the International Myeloma Foundation, an early relapse refers to the first, second, or third time the myeloma progresses after a period of remission. Later relapse (fourth, fifth, and beyond) means that multiple lines of therapy have already been tried. You may eventually reach a stage where everything has been tried.
At this point, your cancer may be considered refractory. Refractory means your cancer is no longer responding to treatment.
You can enter several periods of remission with multiple myeloma during the disease. Every time you relapse, however, it can become more difficult to achieve remission.
It’s important to meet with a doctor, such as a hematologist or oncologist, to evaluate your treatment options. Treatment for relapsed myeloma is highly individualized and based on many factors.
Treatment options may include:
- Chemotherapy drugs: These drugs kill cancer cells or prevent them from growing.
- Corticosteroids: Corticosteroids are often used in combination with other multiple myeloma medications to decrease inflammation and swelling.
- Immunomodulatory drugs: These drugs use your body’s own immune system to help attack cancer cells.
- Proteasome inhibitors: These drugs prevent enzyme complexes called proteasomes in cells from breaking down proteins that help control cell division. This causes the proteins to build up, eventually causing the cell to die.
- Monoclonal antibodies: Monoclonal antibodies attack a specific target, such as proteins on cancer cells that help them grow and divide.
- Bispecific T cell engagers: These are newer antibodies that attach to two targets, one on immune cells and one on cancer cells. This brings the two cells together and helps the immune system attack cancer cells.
- CAR T-cell therapy: This is a type of immunotherapy that involves genetically altering your immune cells to help them attack cancer cells.
- Autologous stem cell transplant: A transplant involves replacing your bone marrow with healthy stem cells that have come from your own body.
If your remission lasted several years, your doctor may recommend re-using the therapy that brought about your remission.
For example, if you were in remission for at least 2–3 years after receiving an autologous stem cell transplant, a second transplant at relapse may be an option for you.
Another option is to add another medication or combination of medications to your initial treatment.
For later relapses, your doctor may recommend trying an entirely new regimen. Typically, this involves a combination of several different drugs from the following drug classes:
- proteasome inhibitors
- immunomodulatory drugs
- monoclonal antibodies
Multiple myeloma relapse is a return of symptoms after a period of improvement. Most people experience several relapses and periods of remission during their disease course. It’s possible to live for many years after a relapse in multiple myeloma, but life expectancy depends on many factors.
Following a relapse, treatment may include a combination of treatment options. You may also wish to consider asking your doctor about participating in a clinical trial investigating new therapies.