Treating the relapse: What’s different about RRMM care strategies?
Fact-checked by At some point in the course of myeloma, you may be diagnosed with relapsed or refractory disease, a stage where the blood cancer has returned after treatment or has not responded well to therapy. Relapsed and refractory multiple myeloma (RRMM) is generally more aggressive and more difficult to treat than newly diagnosed myeloma.
Because of this, RRMM treatment options differ from those for newly diagnosed myeloma. Each time the cancer returns, treatment approaches may change. By working closely with your care team, you’ll be able to choose a strategy that fits your needs at every stage.
The difference between relapsed and refractory multiple myeloma
While often grouped together, relapsed and refractory describe different situations in the context of myeloma:
- Relapsed: The cancer initially responded to treatment or went into remission, meaning disease activity was reduced or eliminated, but signs or symptoms returned later.
- Refractory: The cancer did not respond well to the most recent treatment, with disease progressing during treatment or within 60 days after it ended.
Although these situations are different, they often overlap and may be treated in similar ways, which is why they are commonly grouped together under the term RRMM. As such, this umbrella term includes people who initially went into remission but later relapsed, as well as people who did not achieve remission.
How RRMM care strategies vary
There is no single treatment approach for an RRMM relapse that works for everyone. Your RRMM care plan is individualized and may depend on several factors, including:
- your age
- how long your most recent period of remission lasted
- the stage of your disease and how quickly it is progressing
- your response to, or resistance to, previous treatments
- the number of relapses you’ve had
- your overall health and personal preferences
Treatment decision-making for RRMM can be complex and may change over time. Working closely with your healthcare team can help you choose options that best fit your needs and goals.
Common RRMM treatment approaches
In general, RRMM treatment involves a combination of medications that target the cancer in different ways. RRMM treatment may include:
- Targeted therapies: These interfere with processes cancer cells use to grow and survive. Examples include immunomodulatory drugs, proteasome inhibitors, nuclear export inhibitors, histone deacetylase inhibitors, and antibody-drug conjugates.
- Immunotherapies: These help the immune system better recognize and destroy cancer cells, such as monoclonal or bispecific antibodies, and CAR T-cell therapy.
- Corticosteroids: This class of strong immunosuppressants can slow myeloma cell growth and reduce treatment-related side effects.
- Chemotherapy: These medications kill fast-growing cells, including cancer cells.
- Stem cell transplant: This procedure helps restore the body’s ability to produce healthy plasma cells.
Some first-line medications may also be used for RRMM, although combinations vary. Some RRMM treatments have eligibility requirements. For example, someone may only be eligible for a certain treatment if they have already failed to respond to a specific number or type of other treatments.
Treating the first relapse
After first-line treatment, the first RRMM relapse is an important opportunity to effectively target the cancer, since the chance of remission generally decreases with each additional line of treatment.
The standard approach to a first disease relapse usually involves a three-drug combination. The exact regimen depends on prior treatments and how well they worked, and may include familiar medications and/or new ones.
Stem cell transplants are typically part of first-line treatment for eligible patients, but a second transplant may be considered if the disease returns in select cases.
In some cases, especially if the disease is progressing slowly or not causing symptoms, your doctor may recommend watchful waiting instead of immediate treatment. This involves closely monitoring your symptoms without treatment and starting therapy only if circumstances change. This can help avoid unnecessary side effects.
Treating later relapses
With later relapses, doctors may recommend new three- or four-drug combinations that you haven’t previously received. Advanced therapies, such as CAR T-cell therapy or bispecific antibodies, are often considered.
Some RRMM treatments are only approved after multiple prior therapies have not worked well enough.
Quality of life and personal preferences often play a significant role in treatment decisions at later stages of RRMM.
Supportive care
During treatment, you may continue to experience RRMM symptoms. RRMM treatments can also cause side effects or complications.
Supportive care strategies can help manage symptoms and side effects, improving quality of life with RRMM.
For example, if treatment increases clot risk, your healthcare provider may prescribe blood thinners or aspirin. If infections become more likely, preventive antibiotics, antivirals, or antifungal medications may be recommended.
Monitoring symptoms
During RRMM treatment, close monitoring of symptoms is essential. This helps your care team assess how well treatment is working, spot signs of disease activity, and manage side effects.
Always report new or worsening symptoms — such as pain, fatigue, weight loss, or signs of infection — to your care team. Your doctor may also use lab tests or imaging scans to monitor your response to treatment over time.
Rare Cancer News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
