Part of your multiple myeloma care is monitoring for treatment resistance or the cancer returning. Relapsed or refractory multiple myeloma means that the cancer has come back after responding to prior treatment. Every patient’s situation is different, which is why treatment decisions are highly individualized.
Your care team will consider:
- How long your previous treatment worked
- What therapies you’ve already received
- Your overall health and treatment goals
What treatment options may look like
Combination drug therapies
For many patients, the next step after relapse is a combination of medications and therapies. These treatments often include immunomodulatory drugs, proteasome inhibitors, monoclonal antibodies, autologous stem cell transplantation, and more, working together to target myeloma cells in different ways.
Even if you’ve had some of these drugs before, using them in new combinations can still be effective.
CAR T-Cell therapy
One of the newer options for relapsed multiple myeloma is CAR T-cell therapy—a highly personalized form of immunotherapy that uses your own immune cells to attack cancer.
Memorial Sloan Kettering Cancer Center’s Dr. Saad Z. Usmani describes the process as starting similarly to a stem cell collection: “We take patients’ T cell from the blood. Then, we teach those T cells to identify proteins, like BCMA, on the surface of myeloma cells.”
Once these engineered cells are multiplied and returned to the body, they act quickly. Dr. Usmani explains, “As soon as we infuse the CAR T cells, those CAR-Ts know exactly what to do. They’re going to start eating up the myeloma cells like Pac-Man.”
However, the process does take time. Because the cells must be collected, engineered, and expanded, it can take a couple of months before treatment is ready. During that window, patients often need additional therapy to keep the disease under control. This step, called bridging therapy, helps control the cancer in the meantime.
Bispecific antibodies
Another important and increasingly used option for relapsed multiple myeloma is bispecific antibodies. These treatments build on therapies many patients may already be familiar with, such as monoclonal antibodies.
Dr. Usmani explains that traditional antibodies are designed to recognize a single target on myeloma cells, but bispecific antibodies take this concept a step further. Instead of targeting just one protein, they recognize two: one on the myeloma cell and one on your immune cells. This allows them to physically connect the two.
This dual-targeting approach can be especially powerful, even for patients who have already gone through multiple lines of therapy. Dr. Usmani notes, “It’s very potent even in patients who’ve had the myeloma come back 4 or more times. About 6 to 7 out of 10 patients will have a very good response with the bispecific antibodies. The advantage is if I’m seeing a patient today, I can start that treatment next week.”
Exploring clinical trials
Clinical trials are another important option to consider at this stage. Beyond access to new therapies, clinical trials play a critical role in advancing care. Dr. Usmani emphasizes that the future of myeloma treatment depends on them, sharing that “the first cures will happen on trials.” He also highlights the impact of past participants, explaining that the treatments available today exist because patients “took that leap of faith” to help move the field forward.
For many patients, joining a clinical trial can offer access to promising new therapies while also contributing to progress that may benefit others in the future.
What’s the best treatment choice?
There’s no single “right” treatment for multiple myeloma that’s come back. Your plan is dependent on your individual diagnosis, but know that you have options. Open communication with your care team can help you understand your next steps and feel more confident in your care.
For more insights on treatment options and living with multiple myeloma, watch Dr. Usmani’s full webinar recording.
