This blood cancer can come back after treatment has put it into remission. But there are many options available to help treat a multiple myeloma relapse.

Multiple myeloma is cancer that grows in plasma cells in the bone marrow. Plasma cells are white blood cells that are part of the immune system. They make antibodies that help your body fight infections.

In multiple myeloma, abnormal plasma cells crowd out healthy blood cells in the bone marrow. The cancer cells leave less room for:

  • white blood cells that fight infection
  • red blood cells that transport oxygen to the body
  • platelets that help the blood clot

The cancer cells make abnormal proteins. These proteins can lead to complications such as infections, bone pain, kidney problems, and a low red blood cell count (anemia).

Treatments can put multiple myeloma into remission, which means there are no signs or symptoms of the cancer. But even with successful treatment, some cancer cells may remain in the body. Over time, these cells can begin to grow and divide or become resistant to treatment, and multiple myeloma symptoms can return.

Relapsed multiple myeloma means the cancer has returned after a period of remission. Relapses are common, and many people may experience several periods of remission and relapse during the course of their multiple myeloma.

Read on to learn about the symptoms, causes, and treatment of relapsed multiple myeloma.

A multiple myeloma relapse doesn’t always cause symptoms. Your doctor may detect a relapse through a blood test or imaging scan during a follow-up visit.

If you do experience symptoms, they may be similar to the first time you had multiple myeloma, or you may have different symptoms.

Common symptoms of a relapse include:

  • bleeding
  • bone pain
  • infection
  • shortness of breath
  • tiredness

People with multiple myeloma can go through periods of remission followed by relapses. A majority of people with the condition will eventually relapse or stop responding to treatment. Relapses happen because the cancer cells change in ways that make them more resistant to treatment.

Your cancer may be more likely to come back if:

  • your last remission was short
  • you have an aggressive form of multiple myeloma
  • your cancer cells have certain gene mutations that make them grow faster (called high risk multiple myeloma)
  • you didn’t respond well to past treatments

The odds of relapsing increases with each new treatment you try, according to a study in the British Journal of Haematology. While 74% of people in the study had a good response to their first treatment, only 11% responded well to the fifth treatment.

Managing multiple myeloma involves visiting your doctor every few months to monitor for relapses. During these visits, the doctor will examine you and ask about symptoms such as fatigue, bone pain, and shortness of breath.

Your doctor may use the following tests to monitor you for relapse:

Your doctor can help you decide next steps based on your test results.

Biochemical relapse means you have signs of a relapse on lab tests, but your cancer isn’t growing quickly, and you don’t have symptoms. You may not need treatment right away.

Clinical relapse means the myeloma has grown quickly, and you may have problems such as anemia, bone disease, high calcium levels in your blood, or kidney failure. You may need treatment right away.

Treating relapsed multiple myeloma is a personalized process. You might get the same treatment you had before, a higher dose of the same treatment, or a different treatment.

Your choice of treatment may depend on a number of factors, such as:

  • how many relapses you’ve had previously
  • the length of time since your last relapse
  • how many treatments you’ve had
  • which medications you’ve tried and how well you’ve responded to them
  • how fast-moving the cancer is
  • your age and overall health

Many medications are available to treat relapsed multiple myeloma, including:

  • Chemotherapy drugs: These drugs kill cancer cells or slow their growth. One example is cyclophosphamide (Cytoxan).
  • Immunomodulating drugs: These drugs help your body’s immune system fight cancer cells. Examples include pomalidomide (Pomalyst), lenalidomide (Revlimid), and thalidomide (Thalomid).
  • Monoclonal antibodies: Monoclonal antibodies target a specific protein on cancer cells that helps them grow or spread. Examples include daratumumab (Darzalex), elotuzumab (Empliciti), and isatuximab (Sarclisa).
  • Bispecific T cell engagers: These are newer antibodies that target two different proteins on cells. Examples include elrenatamab (Elrexfio), talquetamab (Talvey), and teclistamab (Tecvayli).
  • Proteasome inhibitors: These drugs stop enzymes in cells from breaking down proteins that help control cell division. Examples include bortezomib (Velcade), carfilzomib (Kyprolis), and ixazomib (Ninlaro).

Often, treatment involves two or three drugs combined with the corticosteroid dexamethasone.

An autologous stem cell transplant may be an option if you haven’t had this treatment before or if you already had a stem cell transplant and your remission lasted for 2 to 3 years. This treatment involves getting high dose chemotherapy, followed by an infusion of healthy stem cells that were removed from your own body.

Clinical trials investigate the safety and effectiveness of new multiple myeloma medications and drug combinations. One of these studies may be an option if your cancer has relapsed. Your doctor can refer you to a clinical trial specialist to see if you’re eligible to participate in any multiple myeloma studies.

If you’ve been diagnosed with relapsed multiple myeloma, you’ll want to make sure you understand your condition and your treatment options. Here are a few questions you may want to ask your healthcare team:

  • How advanced is my cancer?
  • What are my treatment options?
  • Which treatment do you recommend, and why?
  • What is the goal of treatment?
  • How long will treatment last?
  • How will it affect my daily life?
  • What are the possible side effects of treatment?
  • How should I discuss any side effects with my healthcare team?
  • Who on my team can help me manage the side effects I experience?
  • Am I eligible for clinical trials?
  • What is my outlook with treatment?

Multiple myeloma is a cancer that affects white blood cells called plasma cells. Although there’s currently no cure, new treatments have improved the odds of putting the disease into remission and keeping it in remission longer.

Your outlook will depend on many factors, including what treatments you get and how well your cancer responds to them. If you do experience a relapse, there are many other treatments available to help put you into another remission and give you a good quality of life.