Multiple myeloma is a rare type of cancer that begins in the plasma cells of the bone marrow. Doctors cannot cure multiple myeloma, and the natural disease course is remission, followed by periods of active disease. Relapsed refractory multiple myeloma (RRMM) refers to multiple myeloma that is particularly difficult to treat.

Multiple myeloma is relatively rare and only represents around 1.8% of all new cancers diagnosed in the United States annually.

RRMM occurs when someone has already had one or more rounds of treatment for multiple myeloma, and the cancer returns or does not respond to the treatments.

Although specific figures on RRMM are difficult to pinpoint, the International Myeloma Foundation (IMF) states that myeloma relapse is common. Most people with multiple myeloma can experience remissions and relapses throughout the course of the disease.

Read on to learn more about RRMM, its diagnosis, how doctors treat this condition, and where people can get support.

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Multiple myeloma is a type of cancer that affects the white blood cells, specifically the plasma cells. These cells are a critical part of the immune system that help clear infections and prevent disease.

If doctors describe multiple myeloma as refractory, the cancer does not improve with therapy or stops responding to it. Sometimes, the cancer might initially improve but then becomes resistant to treatment and starts growing again — this phenomenon is called relapsed refractory multiple myeloma or RRMM.

Learn more about relapsed multiple myeloma.

Doctors are unsure what might cause multiple myeloma or why some people develop refractory disease. Some factors that can contribute to the disease include:

  • genetic changes
  • having obesity
  • overconsumption of alcohol
  • exposure to environmental toxins
  • exposure to radiation

A person’s genetics may also make the cancer more resistant to treatment.

Initially, someone with multiple myeloma may experience:

If someone has a multiple myeloma relapse, they may have more severe symptoms and poor overall health. They may also experience:

Learn more about the symptoms of multiple myeloma.

Doctors perform various tests to diagnose a multiple myeloma relapse and determine why treatment is not working as it should. These may consist of:

Following the test results, doctors use criteria set by the International Myeloma Working Group to diagnose relapsed multiple myeloma. An individual must meet one or more of the following criteria:

  • a notable increase in plasma cell tumor or bone lesion size
  • abnormally high calcium levels in the blood
  • an unexpected decrease in hemoglobin
  • an increase in serum creatinine, a muscle waste product
  • thickening of blood due to serum protein
  • increases in serum and urinary M protein, which is a protein secreted by abnormal plasma cells

Doctors may integrate a holistic approach to treat RRMM. This approach may depend on the individual’s age, overall health, and any underlying health conditions.

Treatment can also depend on disease-related factors, such as, the type of initial disease, how a person responded to prior treatments, and the aggressiveness of the current relapse.

It is important to note there is no standard therapy approach for people with RRMM.

Treatment regimes may use a combination of drugs. The different drug classes of RRMM treatment are as follows:

  • proteasome inhibitors, which prevent proteins from breaking down and induce cell death
  • immunomodulatory drugs that can modify the immune system
  • corticosteroids, which are anti-inflammatory drugs
  • monoclonal antibodies, which are proteins that bind to certain targets and enhance the immune system response

One regime effective in treating RRMM involves using a proteosome inhibitor called bortezomib, alongside a steroid called dexamethasone. This regime is even more effective when combined with:

  • thalidomide, a type of immunomodulatory agent
  • cyclophosphamide, a chemotherapy agent
  • anthracycline, another chemotherapy medication

Relapsed MM

Relapse treatment aims to relieve symptoms and prevent C.R.A.B. symptoms.

C.R.A.B. stands for:

  • calcium elevation
  • renal insufficiency
  • anemia
  • bone abnormalities

People with multiple myeloma may eventually relapse and become refractory to treatment, despite the advent of newer treatments.

The 5-year overall survival rate remains low, at around 50%. However, outcomes are especially poor for people with RRMM. This may be because the condition becomes less responsive to subsequent lines of therapy. Therefore, it is important for doctors and scientists to find new medications and therapy courses that might prolong survival in people with RRMM.

Some newer therapies might include monoclonal antibodies that interfere with the cell’s machinery and prevent the cancer cells from growing. Treatment courses with monoclonal antibodies have shown promising results, but further research into the overall survival rates of these agents may still be necessary.

Learn more about the outlook for multiple myeloma.

Living with cancer can be challenging. It can be devastating to learn the disease is relapsing and treatment is not working as hoped.

A person may experience a range of emotions, including shock, sadness, anxiety, and anger.

Although these emotions can be overwhelming, some organizations offer support to people with multiple myeloma and their families. Chatting to people online who are living the same experience or attending in-person support groups can help a person feel less alone and more understood.

The IMF provides information about local support groups across the U.S. Likewise, the Multiple Myeloma Research Foundation provides information and support for those living with multiple myeloma and their loved ones.

Multiple myeloma is a type of blood cancer. There is currently no cure, and the disease has cycles of active disease followed by periods of remission.

Relapsed refractory multiple myeloma (RRMM) occurs when an individual has treatment for multiple myeloma, but the cancer returns or does not respond to treatment. Doctors must then use other types of chemotherapy or stronger doses to help put the cancer into remission.