Relapsed multiple myeloma is cancer that returns after a period of remission. Refractory multiple myeloma is myeloma that does not respond to treatment. Your treatment options and outlook can vary depending on which type you have.

Multiple myeloma is a type of blood cancer that forms in plasma cells in the bone marrow. The mutated plasma cells multiply and crowd out healthy plasma cells and stem cells in the bone marrow that form:

  • white blood cells, which help your body fight infections
  • red blood cells, which carry oxygen throughout your body
  • platelets, which help your blood clot

Many people with multiple myeloma experience relapses or their cancer becomes refractory at some point.

Relapsed multiple myeloma means the cancer has returned after it initially responded to treatment and after a period of remission. This may also be called a recurrence.

Refractory multiple myeloma means the cancer does not respond to treatment or starts to respond to treatment and then stops.

This article covers the similarities and differences between relapsed multiple myeloma and refractory multiple myeloma.

After diagnosing multiple myeloma, your doctor will discuss your treatment options. They take into account how fast-moving the cancer is, your overall health, and other factors. While multiple myeloma is treatable, currently there’s no cure.

Initial treatment for multiple myeloma often includes a combination of targeted therapies or chemotherapy. A stem cell transplant for suitable candidates may follow.

After your initial treatment, your cancer might show signs of improvement and your symptoms may subside. At this time, your doctor might say your cancer is in remission.

If the signs and symptoms of your cancer reappear after a period of remission, your cancer is considered relapsed.

A majority of people with multiple myeloma who enter a period of remission experience a relapse. Many people experience several periods of remission followed by relapse.

For some people, first-line treatment for multiple myeloma doesn’t work well. If the cancer doesn’t respond to treatment or it progresses within 60 days of the treatment, it’s considered refractory.

Unlike relapsed multiple myeloma, refractory multiple myeloma never entered a period of remission after treatment.

Your doctor evaluates many factors before deciding on a multiple myeloma treatment plan. These factors may include:

  • your current health
  • how long your cancer has been in remission
  • how many times your cancer has relapsed
  • how well past treatments worked
  • results of lab tests
  • side effects of previous treatments
  • your preferences

There are now many treatment options for relapsed and refractory multiple myeloma.

Your doctor may rely on guidelines set by the National Comprehensive Cancer Network (NCCN) to help decide on a treatment plan. Often, a combination of several types of drugs is used to treat relapsed and refractory multiple myeloma.

These options include:

  • Chemotherapy drugs: These drugs kill cancer cells or prevent them from growing. Examples include cyclophosphamide (Cytoxan), doxorubicin (Adriamycin), and melphalan (Alkeran).
  • Corticosteroids: Corticosteroids are often used with other drugs to help decrease inflammation and swelling. Examples include dexamethasone and prednisone.
  • Proteasome inhibitors: These work by stopping enzyme complexes called proteasomes from breaking down proteins in cells. The proteins eventually build up, causing the cell to die. Examples include bortezomib (Velcade), carfilzomib (Kyprolis), and Ixazomib (Ninlaro).
  • Immunomodulatory drugs: These drugs harness your body’s immune system to fight off cancer cells. Examples include lenalidomide (Revlimid), pomalidomide (Pomalyst), and Thalidomide (Thalomid).
  • Monoclonal antibodies: Monoclonal antibodies target a specific protein on cancer cells that help them grow or spread. Examples include daratumumab (Darzalex), elotuzumab (Empliciti), and isatuximab (Sarclisa).
  • Bispecific T cell engagers: These newer antibodies attach to two separate targets, one on immune cells and one on cancer cells. This brings the two cells together, helping the immune system attack the cancer cells. Examples include elrenatamab (Elrexfio), talquetamab (Talvey), and teclistamab (Tecvayli).
  • CAR T-cell therapy: Chimeric antigen receptor (CAR) T-cell therapy is a type of immunotherapy that involves altering genes inside your immune cells to help them attack cancer cells. Examples include ciltacabtagene autoleucel (Carvykti) and idecabtagene vicleucel (Abecma).
  • Autologous stem cell transplant: This treatment involves getting high dose chemotherapy followed by an infusion of healthy stem cells from your body to help replace cancer cells in the bone marrow.

Relapsed myeloma

If your cancer has been in remission for more than 6 months, your doctor may use the same treatment option that worked the first time.

About 50% of cancers achieve a second remission using the same treatment that brought about remission the first time.

For people who had a stem cell transplant and experienced remission for 2–3 years or longer, a second transplant at relapse may be a good option.

Your doctor may also try a different medication or a combination of medications.

Refractory myeloma

Doctors typically use a different therapy combination than used before to treat refractory multiple myeloma. The combination may include three or four drugs (triplet or quadruplet regimens).

Your treatment plan will be highly individualized and based on several factors, such as your age, overall health, genetics, and what treatments you’ve already tried.

Newer drugs like CAR T-cell therapies are another treatment option for people with refractory multiple myeloma who have already tried several other treatments.

While CAR T-cell therapy can be very effective for many people, it can also cause serious side effects. People receiving CAR T-cell therapy must be closely monitored by their healthcare team.

Though there’s currently no cure for multiple myeloma, recent advances in treatments have greatly improved the outlook. Still, most people experience several remissions and relapses throughout their disease course.

According to the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program database, the overall 5-year survival rate for multiple myeloma is 59.8%.

A 5-year survival rate is an estimate of the percentage of people with the same type and stage of cancer who are still alive 5 years after diagnosis.

These estimates are based on outcomes of studies from the past. They can’t tell you how long you will live, but they might be able to give you a better idea of how well treatment could work.

Relapsed myeloma life expectancy

In general, the earlier the relapse, the worse the outlook. Response to treatment and time of cancer progression can also decrease after each successive relapse.

In a 2016 study involving 511 people with multiple myeloma, the median overall survival in people who received a stem cell transplant and had a relapse within 12 months was 23.1 months, compared with 122.2 months in people who had a relapse after 12 months.

In a 2021 retrospective analysis involving 159 people with multiple myeloma, those who received a second stem cell transplant after their first relapse had a 5-year survival rate of 25%.

Refractory myeloma life expectancy

The outlook for people with refractory multiple myeloma is generally worse than those whose cancers responded to first-line treatments.

In a 2021 study involving 12,987 people with relapsed or refractory multiple myeloma, the median survival time was 32.4 months after starting second-line treatment.

It can be difficult to learn that your cancer isn’t responding to treatment or that it has relapsed, but advances in treatment have improved the outlook for people with multiple myeloma.

People with this cancer have more treatment options than ever before.

Here are some questions you may wish to ask your doctor at your next appointment:

  • What are my treatment options?
  • Will I be taking the same treatment or a new one?
  • What side effects can I expect?
  • How can I manage these side effects?
  • What diet or lifestyle changes can help improve my quality of life?
  • How much will my treatment cost with or without insurance?
  • What’s my outlook?
  • What support groups are available in my area?
  • Would you recommend joining any clinical trials?

At this time, there’s no cure for multiple myeloma. Most cases of multiple myeloma eventually relapse or become refractory to treatment at some point.

But many treatment options are available, and clinical trials continue to evaluate new drugs and combination approaches.

Newer therapies such as CAR T-cell therapy have shown impressive results even in cancers that have relapsed or not responded to multiple prior treatments.