Managing relapsed myeloma with new treatment options

A relapse of blood cancer does not indicate that the first treatment failed. For patients with multiple myeloma—a cancer of the plasma cells in the bone marrow—a return of the disease after remission is common, but it does not mean earlier treatment was ineffective. Instead, it shows that the disease has evolved, requiring a different approach.

Tulio Rodriguez, MD, a hematologist-oncologist and director of the Bone Marrow Transplant and Cellular Therapy Program at City of Hope Cancer Center Chicago, states that myeloma can be controlled for years, even decades, but it may return despite effective initial treatment. “A relapse is often a reflection of the nature of multiple myeloma rather than a sign that their initial treatment was unsuccessful,” he said. The original treatment goals remain valid: extending survival, maintaining quality of life, and controlling the disease. A relapse simply means doctors must reassess and adjust the strategy.

Amrita Krishnan, MD, executive medical director of hematology at City of Hope Orange County in Irvine, California, supports this view. “Remissions can last for years even though the disease may eventually return,” she said. Today’s treatments offer many effective options for relapsed myeloma, even if the disease progresses.

The core treatment goals, survival, quality of life, and disease control, remain unchanged after a relapse. What shifts is how doctors achieve them. Rodriguez explains that care teams evaluate how the disease responded to prior therapies, how long that response lasted, the patient’s overall health, and any new treatment options that may now be available. “We look at how the disease responded to prior therapies, how long that response lasted, the patient’s overall health, and any new treatment options that may now be available,” he added.

New therapies now used earlier in treatment

Advances in myeloma treatment provide patients with access to therapies that did not exist when they first began treatment. For example, CAR T-cell therapy, where a patient’s immune cells are reengineered to attack cancer, and bispecific antibodies, which help immune cells target and destroy cancer cells, are now used earlier in treatment. “We focus on matching the best treatment to the right patient at the right time,” Rodriguez states.

Krishnan adds that timing is important because a patient’s health can determine which treatments are safe. “Patients are frequently in better overall health earlier in their treatment journey, which can make them better candidates for advanced therapies,” she continued. Using these treatments sooner “may lead to deeper, longer-lasting responses.” However, the most intensive options are not suitable for everyone, and care teams help determine the best approach.

Why online survival stats can be misleading

Online survival statistics can mislead patients with relapsed myeloma. Rodriguez warns that population-based numbers provide a broad understanding of the disease but do not predict individual outcomes. Factors like overall health, disease biology, response to treatment, and access to newer therapies influence results. “Some of the statistics patients find online may reflect people who were treated before many of today’s therapies were available,” Dr. Krishnan said.

This means survival rates may not reflect current treatment possibilities. For instance, a patient treated in 2010 likely had fewer options than someone treated in 2024. Doctors emphasize that personalized care, considering a patient’s unique history and priorities, matters more than general statistics.

After relapse, treatment becomes more individualized. Care teams assess how quickly the myeloma returned, prior treatments used, their effectiveness, and any side effects experienced. Personal priorities also guide decisions: some patients prefer intensive therapies for deeper responses, while others prioritize minimizing side effects or reducing treatment time.