Has Your Multiple Myeloma Treatment Stopped Working?

Multiple myeloma (often called myeloma) affects plasma cells, a type of white blood cell found in your bone marrow. It means some of these cells have become cancerous and can crowd out the healthy blood cells in your bone marrow. Treatment can keep the condition in check. But when treatment stops working, myeloma cells start growing again. It’s called a relapse.

Relapse is common for people with multiple myeloma. In fact, this cancer is known as a “remitting and relapsing” disease. That means you can probably expect your myeloma to get better -- and then worse -- multiple times while you have the disease.

Nobody with cancer wants to learn their treatment stopped working. But if you have multiple myeloma, you have plenty of choices to discuss with your doctor if your therapy no longer helps you.

Signs Your Treatment Stopped Working

New symptoms may be a clue that your multiple myeloma treatment isn’t working anymore. They can include:

  • Bone pain
  • Nausea
  • Constipation
  • Not feeling hungry
  • Mental fogginess
  • Fatigue
  • Getting a lot of infections
  • Weight loss
  • Leg weakness or numbness
  • Feeling very thirsty

Be aware that even if you don’t have symptoms of myeloma, it could still be growing inside your body. That’s why it’s important to see your doctor for regular checkups to keep tabs on your condition.

Your doctor may use a few tests to check the status of your disease. Different people may get different tests, depending on their treatment history and other things, but the options include:

  • Blood tests
  • Urine tests
  • Imaging tests, such as X-rays, MRIs, CT scans, PET scans, and bone density scans
  • Bone marrow tests, including aspiration and biopsy, where doctors take samples of your bone marrow to check for signs of cancer

When Early Treatments Stop Working

People often begin multiple myeloma treatment with a three-drug regimen known as VRd. It includes:

Sometimes, doctors recommend a combination of drugs, depending on your needs. Examples include:

  • Velcade, cyclophosphamide (Cytoxan), and dexamethasone (VCD)
  • Revlimid and dexamethasone (Rd)
  • Velcade and dexamethasone (Vd)

Continued

After your first round of chemo, the doctor will probably talk to you about a stem cell transplant if it’s a good fit. That’s when doctors take healthy blood cells from other people and put them into your body. They might follow it with more chemotherapy.

These treatments typically work well for a while. But you may need to switch medications if and when your myeloma relapses.

People who have had one to three prior therapies can switch to a medicine they haven’t tried before. These drugs include:

You might take other drugs along with those medicines, too. Daratumumab (Darzalex), Velcade, and dexamethasone; or Darzalex, Revlimid, and dexamethasone can work well for people who have tried one to three treatment plans in the past.

If you’ve tried two or more treatment plans in the past, your doctor may suggest the drug combo of Darzalex, pomalidomide (Pomalyst), and dexamethasone.

Late-Stage Treatment Options

Eventually, some myeloma drugs, including Velcade and Revlimid, may not be able to fight your cancer anymore.

You may be disappointed, but you shouldn’t lose hope. Several other drugs and drug combinations are available. After those, you may want to think about joining a clinical trial. These research studies test new medicines or new uses for existing drugs to see how well they work. Your doctor can help you find a clinical trial that may be right for you.

WebMD Medical Reference Reviewed by Melinda Ratini, DO, MS on June 24, 2020

Sources

SOURCES:

Multiple Myeloma Research Foundation: “What is Multiple Myeloma?”

Mayo Clinic: “When cancer returns: How to cope with cancer recurrence,” “Multiple myeloma.” 

International Myeloma Foundation: “What is Relapse?” “Treatments for Subsequent Relapse,” “Frontline Treatment Options.” 

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