Starting a New Treatment for RRMM

Medically Reviewed by Brunilda Nazario, MD on August 25, 2023
Written by Stephanie Booth
4 min read

Relapsed/refractory multiple myeloma (RRMM) doesn’t have a cure. But many treatments can ease symptoms and slow the cancer’s growth. If the medicines you’re taking stop working, you and your doctor can choose a new treatment that makes sense for you.

RRMM is multiple myeloma that returns after you’ve been cancer-free for a while, stops reacting to treatment, or both. 

Your doctor is very likely to suggest you start a new treatment: 

  • If you have pain or any other symptoms related to MM and its related problems
  • If tests show cancer cells are growing again
  • Based on your recent lab tests, such as blood and urine test results, and overall medical history

Your doctor might suggest you try a treatment you’ve had for RRMM before, especially if it worked well for you the first time. But you can also try something different.

  • Chemotherapy. Drugs like cyclophosphamide destroy fast-growing cancer cells.
  • Monoclonal antibodies. These antibodies put a target on cancer cells so your immune system can find and attack them more easily.
  • Proteasome inhibitors (PIs). These special medicines kill myeloma cells from the inside out.
  • Immunotherapy. Newer treatments like CAR T-cell therapy use your immune system as a weapon to fight cancer cells.
  • Immunomodulatory agents (IMiDs). Immunomodulatory means that the medicines (or agents) change (or modify) your immune system so your body can defend itself against illness better. Thalidomide, lenalidomide, and other medicines stop cancer cells from growing and taking over your bone marrow. A bone marrow (or stem cell transplant), called a hematopoietic cell transplant (HCT) by doctors, helps people who have RRMM make new blood cells. 

Your doctor might also suggest you join a clinical study, which lets you try brand new medicines that researchers are testing.

When choosing your next RRMM treatment, you and your doctor have to consider a few things: 

  • Your age. The older you are, the more likely you are to have sideeffects.
  • The treatments you may have already tried while you were relapse-free.
  • Your health. Some RRMM treatments can worsen heart or kidney conditions. 
  • How fast the cancer is spreading.
  • Your treatment goals. 
  • Your access to care – for example, whether your health insurance plan covers the RRMM treatment you’d like to try. You can also discuss whether it’s easier for you to take a daily pill at home instead of having to visit a treatment center often.

RRMM treatments often last between 21 and 35 days. You usually don’t have to be admitted to the hospital to have treatment unless you have an infection or your bones or organs are damaged. 

During treatment, you might take some medicines every day and other medicines every few days or so. 

You can take RRMM medicines as a pill, a shot, or by IV. It’s common to get between four and six cycles of treatment. But your doctor may also suggest you keep the treatment going until it stops being helpful. 

Newer RRMM treatments may involve more steps. For instance, if your doctor thinks CAR T-cell therapy can help you, a board of doctors may need to confirm whether the therapy is a good fit for you. You also have to ask your health insurance company if your plan covers the treatment. Once you’ve cleared those hurdles, you take medicines for several weeks to prepare your body for CAR T-cell therapy.

Before you start a new treatment, write down a list of questions to ask your doctor. You might ask:

  • Why do you think this treatment could help me?
  • Where will I have this treatment? How is it given?
  • How many treatment sessions will I have? 
  • How will I feel after each session? 
  • Are there any side effects I should tell you about right away?
  • Are there any side effects that might not go away?
  • How can I prevent or treat any side effects?
  • When will we know if the treatment is working?
  • If this treatment doesn’t help me, what else could we try? 
  • Who can I call if I have questions?
  • What will happen if I don’t get this treatment?

It’s entirely up to you whether you start or stop a new treatment. People stop cancer treatment for many reasons. If you’re thinking about stopping treatment, talk to your doctor: Find out the pros and cons of not starting a new treatment or stopping a treatment you’re already having. It’s also important to ask how you can keep getting care for pain and other side effects.

It can be difficult to know there is no cure for RRMM and that the cancer might return at some point. Think about the kind of support you might need as you begin treatment again. You may find it helpful to:

  • Talk to friends and family.
  • Join a support group for people who live with RRMM.
  • Speak to a counselor or therapist.
  • Ask your doctor’s office for more resources.