Treatment Decisions in Relapsed/Refractory Myeloma

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Treatment selection for patients with relapsed or refractory multiple myeloma depends on many different factors, as discussed by Noopur Raje, MD, and Sagar Lonial, MD. Lonial states that among the factors to consider are length of initial remission, which initial therapy they received, side effects and toxicities from initial therapy, results of genetic testing, and whether the relapse is slow or aggressive. There are many treatment options that physicians can choose from, and Raje notes that treatment is individualized for each patient, taking into account the patient’s clinical profile.

Lonial comments that there is no single preferred treatment regimen or algorithm for relapsed multiple myeloma. A patient can be retreated with the same drug or regimen that was used as initial therapy, state Raje and Lonial. For example, Lonial notes that even if the patient has become resistant to a certain drug as part of combination therapy, he may retreat with the same drug along with a second agent to re-establish sensitivity. Raje remarks that there are many options for the treatment of relapsed multiple myeloma, and that it is important to look at a patient’s comorbidities and previous regimens when deciding on a treatment plan.