When cancer treatment stops working, a person should consult their oncologist. Next steps may include reevaluation, trying new therapies, transplant, and palliative or hospice care.

Although newer treatments have improved long-term survival rates, multiple myeloma has a very high risk of coming back, even after successful treatment. This is known as relapsing myeloma.

Refractory myeloma, by contrast, is myeloma that never responds well to treatment.

Most oncologists say multiple myeloma relapse is inevitable. Following relapse, survival rates shorten, and treatment options decrease.

Still, monoclonal antibodies, proteasome inhibitors, and autologous stem cell therapy are often helpful.

While multiple myeloma has no cure, the right care can extend a person’s life and reduce their pain. Certain factors, including the disease stage, a person’s age, health status, and others, may influence treatment goals.

Learn more about the next steps after multiple myeloma treatments stop working.

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A person can only know that their myeloma has relapsed with medical testing.

Changes in symptoms or feeling worse are not necessarily signs of a relapse.

Following signs and symptoms of relapse, a person can consult their doctor about treatment options.

Some questions to ask a doctor include:

  • Which treatment options are good options for me and why?
  • What are the side effects of various treatments?
  • Which treatments are most likely to prolong my life and why?
  • What is my life expectancy with and without treatment?
  • What can we do to reduce the side effects of treatment?
  • Are there clinical trials available that I am eligible for?

Some people opt to treat myeloma aggressively. Others prefer to avoid treatment side effects and pursue hospice care.

Many people choose a middle option, initially seeking aggressive treatment and then switching to a hospice model when treatment is not working and side effects become intolerable.

No matter which approach a person selects, they can receive palliative care to assist with any physical or emotional symptoms or side effects.

If a person wishes to, they can seek a second opinion. This can be helpful since treatment recommendations can vary.

Multiple myeloma treatment may stop working. Or, a relapse may occur after stopping treatment with a drug that initially obtained good results.

Before changing treatments, it is essential to discuss the following with a doctor:

  • what treatments are available
  • possible and common side effects
  • available support to manage side effects
  • risks and benefits
  • how long each treatment will likely prolong a person’s life

In most cases, doctors suggest treatment based on how well a person’s condition responds to lenalidomide (Revlimid).

If progression stops for 60 days or longer, a person will remain on maintenance lenalidomide. If cancer continues to progress or begins progressing again before 60 days, the person has lenalidomide refractory disease. They must pursue other treatment options.

In most cases, doctors use combinations of drugs to treat refractory disease. For example, a person might take a combination of the following:

Triple and quadruple drug therapies typically produce better results than the combination of lenalidomide and dexamethasone alone.

Several newer multiple myeloma therapies have recently gained Food and Drug Administration (FDA) approval, including:

CAR T-cell agents

These drugs train the immune system’s T cells to attack cancer cells.

In 2021, the FDA approved the CAR T-cell therapy idecabtagene vicleucel (Abecma) for people who had previously undergone four or more therapies.

In 2022, another CAR T-cell drug, ciltacabtagene autoleucel (Carvykti), gained FDA approval.

Learn more about CAR T-cell therapy.

Monoclonal antibodies

Another newer treatment is an anti-CD38 monoclonal antibody that targets CD38. CD38 is a glycoprotein highly expressed on multiple myeloma cells.

In 2023, the FDA approved two additional new therapies in a new class of drugs, talquetamab-tgvs (Talvey) and elranatamab (Elrexfio). These are bispecific antibodies. They target different proteins heavily expressed on multiple myeloma cells.

Both drugs prolonged most clinical trial participants’ lives by at least 9 months.

Stem cell transplantation can be an effective treatment for people whose multiple myeloma initially had a good response to treatment, as well as healthy people with primary refractory multiple myeloma. This is a type of multiple myeloma that initially responds poorly to treatment.

Older and very sick people may not be good transplant candidates. Many other groups may be ineligible.

In many cases, stem cell transplant works best combined with other therapies that usually start several months post-transplant.

Palliative care focuses on managing pain and improving quality of life rather than treating the disease. Unlike hospice care, though, it does not require a person to stop treatment.

A person can receive palliative care any time after receiving their multiple myeloma diagnosis. Most people benefit from having palliative care as an extra layer of support throughout their cancer experience.

Palliative care may include the following:

  • pain medication
  • various therapies
  • psychological support
  • pain-reducing treatments

A person may have to ask about palliative options or seek a consultation with a palliative care specialist

Hospice care supports people at the end of their life, usually those with a life expectancy of 6 months or fewer.

Hospice endeavors to reduce pain and suffering, even if doing so does not prolong a person’s life.

For this reason, transitioning to hospice usually means ending treatments that aim to cure the disease.

In hospice, a person gets support for pain as well as emotional, psychological, and spiritual support. Hospice care may also offer support to loved ones and people who are helping make end-of-life decisions.

Myths about hospice care are prevalent. Transitioning to hospice care does not shorten a person’s life. Instead, hospice care offers support when a person has exhausted all treatment options or wishes to discontinue treatment.

Learn more about the difference between hospice and palliative care.

When a person wishes to continue treatment, an oncologist can help them make an informed choice about the next steps.

Hospice and palliative care can connect a person to many support and treatment resources. People may wish to connect with the following organizations:

Psychotherapy with a therapist specializing in life-limited conditions may be helpful for the person with cancer and their loved ones.

Multiple myeloma can be overwhelming to cope with as it is a terminal disease. Still, several treatment options may remain. A person can try newer therapies, get pain management support, or explore palliative care options.

People with multiple myeloma can maintain open communication with an oncologist and learn as much as possible about treatment options, risks, and benefits to inform their decision-making.