Understanding Relapsed Refractory Multiple Myeloma

Relapsed refractory multiple myeloma (RRMM) is a challenging form of multiple myeloma. It is very common for people with multiple myeloma to have a relapse. And there are times when the disease does not respond to multiple rounds of treatment.^1,2

This situation can be difficult to face. However, many treatments are available for those who have had failed treatments in the past, and new therapies are being developed.^1,2

What does “relapsed refractory” mean for people with multiple myeloma?

When multiple myeloma returns after a period of improvement, it is known as a “relapse.” This means the cancer has become active again.^1,2

“Refractory” means the cancer is not responding to treatments. These may be treatments that previously worked or new therapies. If your myeloma is both relapsed and refractory, it means it has returned and is resistant to standard therapies.^1,2

Some people with RRMM may go through stages of active disease and remission (no evidence of disease). As the disease progresses, the periods of remission tend to get shorter and the cancer often becomes more difficult to treat.²

What are the treatment options for RRMM?

Even if your multiple myeloma is relapsed and refractory, there are treatments available to you. New options also are being developed, giving people with RRMM more hope than before.^1-3

Your treatment protocol depends on several factors, including:²

• Your current health
• How many times the cancer has relapsed
• How long you have been in remission
• How well your disease has responded to previous treatment
• The type(s) of treatment you have had in the past

Combination therapies

Combination therapy is a common treatment method for RRMM. Combination therapy refers to doctors using 2 or more drugs together to target the cancer. These combinations will be different from the drugs you used before. They may include:^1-3

• Proteasome inhibitors – Drugs that prevent cancer cells from breaking down proteins
• Immunomodulators (IMiDs) – Drugs that treat cancer by impacting the immune system
• Monoclonal antibodies – Antibodies designed to treat multiple myeloma by targeting proteins on cancer cells or attaching to both cancer cells and immune cells to help the immune system target the cancer (some monoclonal antibody treatments may be used alone)

CAR T-cell therapy

This is a newer form of immunotherapy. It uses your own immune cells, which are modified in a lab, to attack cancer cells. Certain forms of CAR T-cell therapy have shown promising results in people with RRMM.^1,3

Stem cell transplant

If you are healthy enough, your doctor may recommend a stem cell transplant. First, you receive high-dose chemotherapy, which destroys cancerous blood cells. Then, healthy stem cells are infused into your body. The healthy transplanted stem cells are collected from you before treatment (this is called an autologous transplant).^1-3

Clinical trials

RRMM clinical trials are new studies that test the latest treatments. They may provide you with access to therapies that are not yet widely available.^1,2

You can learn more about clinical trials by talking to your doctor or visiting the ClinicalTrials.gov website. Your doctor can help you decide if you qualify to participate in a clinical trial and which one may be right for you.

Watchful waiting

For those with stable, slow-growing disease, watchful waiting may be a treatment approach. This means that instead of starting treatment right away, doctors closely monitor your condition through regular checkups and tests. This allows you to avoid the potential side effects of treatment until it becomes necessary.²

Watchful waiting may be recommended if your multiple myeloma is not causing symptoms or affecting your daily life, but this is unlikely for people with RRMM. It ensures that treatment begins only when it is truly needed, helping to maintain your quality of life for as long as possible.²

What is the prognosis for people with RRMM?

After multiple failed treatments, living with RRMM can feel uncertain and scary. But many people continue to lead fulfilling lives with the right care and support. The prognosis of RRMM varies. It depends on several factors, such as:^1,2

• Age
• Overall health
• How well the disease responds to treatment

Advances in medicine mean that many people with RRMM now live longer and have a better quality of life. Managing symptoms and side effects is a key part of care. Work with your doctor to address symptoms and any side effects from new treatments.²

Support groups and counseling can also help you cope with the emotional challenges of RRMM. You are not alone in this journey.²

What questions should I ask my doctor if I have failed multiple treatments?

If your treatment is not working, talk openly with your doctor. Here are some questions to consider:

• Why is my current treatment not working?
• What are my next options?
• Are there any clinical trials I can join?
• What are the risks and benefits of starting a new treatment?
• How can I manage side effects or symptoms better?
• What can I do to improve my quality of life?
• Should I consider palliative care to help manage my symptoms?