Relapsed/Refractory Patients:

Your Top Questions Answered


Empowering Relapsed/Refractory Patients


Over the years, the Multiple Myeloma Research Foundation (MMRF) has collected questions from patients like you, who have relapsed or are refractory to treatment. Here you will find answers to the most frequently asked questions.

Click a link below to view by topic:

1. What are my treatment options?
2.Is high-dose chemotherapy and stem cell transplantation an option?
3. Do I need a second opinion?
4. What new drugs are being developed?
5. How do I know if a clinical trial is right for me?
6. What are the types of clinical trials?
7. How do I find the right clinical trial?
8. Where can I find help paying for treatment?

1. What are my treatment options?

Fortunately, there are many treatment options for patients with relapsed or refractory myeloma. Any of the treatments used in initial therapy (e.g., Revlimid, Thalomid, Velcade) may be potential treatment options. Even if you have been on a treatment before, it may work again. Alternatively, a new combination of drugs may be effective (e.g., Velcade plus Doxil or Velcade plus Revlimid).

Learn more about how multiple myeloma is treated.

Use the links below to find out more about specific treatments.

Velcade® (bortezomib) for Injection
Revlimid® (lenalidomide)
Kyprolis™ (carfilzomib) for Injection
Pomalyst® (Pomalidomide)
Thalomid® (thalidomide)
Doxil® (doxorubicin HCl liposome injection)
High-Dose Chemotherapy and Stem Cell Transplantation
Bisphosphonates
Radiation Therapy
Orthopedic Interventions
Growth Factors

Participation in a clinical trial is also an option. Participating in a clinical trial offers access to the very latest advances in treatment. Many new drugs are being studied in combination with standard therapies. Therefore, you should always talk to your doctor about what clinical trials may be appropriate.

Find a clinical trial that may be right for you or call 1-866-603-MMCT (6628) to speak with a Clinical Trial Specialist

2. Is high-dose chemotherapy and stem cell transplantation an option?

Patients who respond or obtain stable disease after treatment for relapsed or refractory myeloma may be eligible to undergo high-dose chemotherapy and stem cell transplantation. In addition, a second stem cell transplant is sometimes performed in patients who have relapsed after an initial stem cell transplant.

In order to be a candidate for stem cell transplant, you should be in generally good health, although some patients with kidney failure have been able to undergo transplant using lower doses of chemotherapy. However, if you have previously received certain types of myeloma treatment (such as melphalan or radiation to the pelvic area) you may not be able to undergo transplantation.

Learn more about high-dose chemotherapy and stem cell transplantation.

3. Do I need a second opinion?

It is recommended that people with relapsed or refractory multiple myeloma seek a second opinion from a doctor with expertise in treating multiple myeloma before beginning a new treatment regimen. In fact, most doctors will encourage patients to see more than one doctor before proceeding with treatment. Doctors at larger cancer centers in particular may have more knowledge about treating multiple myeloma and access to more clinical trials specifically for patients with relapsed or refractory disease.

Visit our sister organization, the Multiple Myeloma Research Consortium (MMRC), for more information about cancer centers that specialize in multiple myeloma. Visit the National Cancer Institute's (NCI) designated cancer centers. Or, visit the American Society of Hematology's "Find a Hematologist" to locate doctors who specialize in treating blood cancers.

4. What new drugs are being developed?

More than 50 new drugs are at various stages of development for multiple myeloma, including eight that are in Phase III clinical trials. Examples of promising myeloma drugs in this stage of testing include Carfilzomib, Elotuzumab, and Pomalidomide.

Carfilzomib is a proteasome inhibitor that is given as an injection into a vein (intravenously). Early studies have shown that carfilzomib is active in advanced myeloma when used by itself. However, it is even more effective when combined with Revlimid and dexamethasone, and is active in high-risk myeloma. Carfilzomib is being evaluated alone and in combination with Revlimid-dex in two Phase III trials, as well as in combination with other agents in early-stage trials, in relapsed and/or refractory disease. Carfilzomib is also being studied in combination with other anti-myeloma therapies in early-stage trials in newly diagnosed, previously untreated myeloma. Learn more about Carfilzomib.

Elotuzumab, also known as HuLuc63, is a monoclonal antibody that binds to a substance that is on the surface of myeloma cells. It is given intravenously. Early studies have shown that combinations of Elotuzumab and Velcade or Revlimid are active in advanced myeloma. Based on these early studies, two Phase III trials are evaluating whether adding Elotuzumab to Revlimid-dex will increase the length of time before the disease progresses. Learn more about Elotuzumab.

Pomalidomide, also known as CC-4047, is an oral immunodulatory agent (IMiD™). Although active in advanced myeloma when used by itself, Pomalidomide is more effective when given along with dexamethasone. It is also active against myeloma that no longer responds to Velcade and Revlimid. Pomalidomide is being evaluated in advanced myeloma alone and in combination with dexamethasone in Phase III trials, and as part of several combination therapies in early-stage trials. Learn more about Pomalidomide.

5. How do I know if a clinical trial is right for me?

Deciding to participate in a clinical trial is an important decision. For many people with multiple myeloma, a clinical trial may be the best treatment option available. Other people with multiple myeloma may want to help contribute to the development of better treatment options in the future. Understanding more about clinical trials will help you make the right decisions. Learn more about multiple myeloma clinical trials, or talk with your doctor or a Clinical Trials specialist at 1-866-603-MMCT (6628) about any questions you may have.

6. What are the types of clinical trials?

Clinical trials are usually classified into one of three phases.

The goal of a phase I clinical trial is to prove that a new drug or treatment may also be given safely to people. Data is collected on how a new drug should be given (by mouth, injected into the blood, or injected into the muscle), how often, and what dose is safe. People who participate in a phase I clinical trials are often the first to receive a new treatment.

The goal of a phase II clinical trial is to learn more detailed information about the safety of the treatment and to begin studying how well the drug works.

The goal of a phase III clinical trial is to study how a new treatment compared with the current standard of care. In phase III trials, data are collected from large numbers of patients to determine whether the new treatment is more effective and possibly less toxic than the current standard treatment. In most phase III clinical trials, patients are randomly selected to receive either the new treatment being studied in the clinical trials or the current standard treatment.

Learn more about clinical trials.

7. How do I find the right clinical trial?

With so many clinical trials for multiple myeloma, it is very important to choose the right one. Most people have several factors to consider, including the stage of the disease, the treatments under study, and considerations such as the location of the trials and travel costs. Before making your decision, talk with Clinical Trials specialist at 1-866-603-MMCT (6628) about clinical trials that may be best for you.

8. Where can I find help paying for treatment?

The cost of treating multiple myeloma can be high and may include unexpected out-of-pocket expenses. People with multiple myeloma may want to seek financial help soon after being diagnosed. Most hospitals and clinics have social workers who can help patients and their families manage financial concerns and provide access to community resources. Your doctor or oncology nurse may also be able to provide a referral to resources available in your community. View our list of resources to assist with treatment costs.

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