Treatment when myeloma comes back (relapses)

Treatment for myeloma helps to control symptoms, improve quality of life and helps you live longer. It can’t usually be cured. Treatment aims to control it so that it isn’t active, and you don’t have symptoms. This is when it is in remission.

When it comes back it is called a relapse and you need more treatment. Often the disease relapses slowly so you may not need further treatment straight away. During the course of the disease you might have several relapses.

What treatment will I have for myeloma that has come back?

When you relapse your treatment plan depends on:

  • how long your myeloma has been in remission
  • the treatment you had before
  • how well the treatments you have had worked
  • your general health

Like your first treatment, you usually have a combination of

  • targeted cancer drugs
  • steroids
  • possibly chemotherapy

Most people have treatment as an outpatient. This is unless there is another reason to be in hospital. This might include an infection, severe bone damage or severe kidney damage.

Treatment can be tablets alone, or tablets together with an injection just under the skin, or into a vein as a drip (intravenously).

You have treatment in cycles or blocks. Each cycle lasts for between 21 and 35 days. You have some drugs every day and others weekly. After each cycle of treatment, your team will monitor your side effects. They will also check how well treatment is working. Most people have between 4 and 6 cycles of treatment. But some treatments carry on until they stop working, such as lenalidomide and daratumumab.

First relapse

The first time your myeloma comes back it is called a first relapse. You might have the same combination of drugs you had as your first treatment if your myeloma has been in remission for longer than 18 months. But it is more likely that you will get another combination of drugs.

At first relapse you might have:

Bortezomib

You have this as an injection just under the skin or into your vein as a drip. You have it with steroids or with other drugs

Each cycle lasts 21 or 35 days. You usually have up to 8 cycles of treatment.

Daratumumab with bortezomib

Daratumumab is a type of antibody and helps your immune system to recognise and kill the myeloma cells. You have it as an injection under the skin as a drip into your bloodstream. This starts as once a week but gets less often after a couple of months, and is eventually given every 4 weeks. You also have dexamethasone (a steroid). You carry on taking daratumumab until it stops working.

You have bortezomib once or twice a week. You usually have it for up to 24 weeks.

Thalidomide or lenalidomide 

You take these as capsules along with steroid tablets.

You take thalidomide every day. You usually have up to 9 months of treatment. Sometimes you might carry on taking thalidomide until it stops working. 

Lenalidomide is given as cycles of treatment. Each cycle lasts for 28 days. You take lenalidomide capsules once a day for 21 days and then you have no treatment for a week. And then you start taking it again. You carry on taking lenalidomide until it stops working.

Ixazomib (also called Ninlaro)

It works in a similar way to bortezomib. You take it as a tablet once a week for 3 weeks and then have no treatment for a week. And then you start taking it again. You usually take lenalidomide tablets with it. 

Stem cell transplant 

 If you haven’t already had a stem cell transplant you might have one or if you have already had one you might have a second one.

After first relapse

When it comes back again, it is called a second relapse, third relapse, and so on.

You might have one or a combination of these:

Ixazomib (also called Ninlaro)

It works in a similar way to bortezomib. You take it as a tablet once a week for 3 weeks and then have no treatment for a week. And then you start taking it again. It is usually given with lenalidomide.

Daratumumab with bortezomib

Daratumumab is a type of antibody and helps your immune system to recognise and kill the myeloma cells. You have it as an injection under the skin or as a drip into your bloodstream. This starts as once a week but gets less often after a couple of months and is eventually given every 4 weeks). You also take dexamethasone (a steroid). You carry on having daratumumab until it stops working. 

You have bortezomib once or twice a week. Usually you have bortezomib for up to 24 weeks. 

Pomalidomide (pronounced pom-a-lid-oh-mide)

This is also called Imnovid. It works in different ways including helping your immune system and stopping myeloma cells developing. You take pomalidomide as capsules with a glass of water. You need to swallow the capsules whole. You take pomalidomide as cycles of treatment. Each cycle lasts 28 days. You take pomalidomide for 21 days and then no treatment for a week. And then you start taking it again. You carry on taking pomalidomide until it stops working. 

Carfilzomib (also known as Kyprolis)

It works in a similar way to bortezomib. You have it as a drip into your bloodstream. You have carfilzomib as cycles of treatment. Each cycle lasts 28 days. You have carfilzomib on days 1, 2, 8, 9, 15 and 16 of each cycle. You also take steroid tablets. You carry on taking carfilzomib until it stops working. 

Panobinostat with bortezomib  

Panobinostat is also called Farydak. It works by stopping the myeloma cells growing by interfering with the proteins in the cells. It is a tablet you swallow whole with a glass of water. You have treatment as cycles of treatment. Each cycle lasts for 21 or 28 days. You usually have 8 cycles of treatment. 

You might have other drugs as part of a clinical trial if you have already had 2 or more treatments.

Other treatments to prevent problems

Myeloma can damage your bones which can cause pain and fractures. To try to prevent this your doctor will offer you a medicine called a bisphosphonate.

The most common bisphosphonates are pamidronate and zoledronic acid (Zometa). You have them into the vein as a drip (intravenously) every 4 weeks.

These drugs can affect healing after dental treatment. So it is better to see your dentist for a check up before starting treatment. 

Myeloma and its treatment can increase your risk of having a blood clot. Your doctor might suggest you have treatment to reduce your risk of having a blood clot. This might be tablets or an injection just under the skin.

Treatment can increase your risk of infection. Your doctor might suggest you have the flu vaccination. They might also give you antibiotics and antivirals to reduce your risk of infection.

Changes in bowel habit are common during treatment. You might have medicines to stop constipation or diarrhoea. And treatment can cause indigestion so you might also have medicines to stop indigestion.

Treatment for symptoms

Myeloma can affect you in different ways. There are treatments that can help to control or reduce the symptoms of myeloma.

Coping with relapse

Myeloma can be difficult to cope with. Knowing that it is going to come back at some point but not knowing when is especially difficult. The time between remission and relapse varies from person to person. Some people have months and others have years. Living with uncertainty is hard. And when it does come back it can feel very difficult even when you have known it will happen.

The type of support people need also varies. Finding what works for you is important. Talking to family and friends helps many people. There is also help and support available from specialist nurses, counsellors and support groups.

Last reviewed: 
31 Jul 2020
Next review due: 
31 Jul 2023
  • Myeloma: diagnosis and management (2018)

    National Institute for Health and Care Excellence

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