What Are the Treatment Options for a Multiple Myeloma Patient Who Experiences Their First Relapse After Having Been in Remission and on Maintenance Therapy?

The goal, as previously stated, is to send the patient into remission, or have the patient be MRD negative, which means that no disease was detected after treatment. Once remission is achieved, a patient is then put on maintenance therapy, which is a drug regimen intended to make the remission last as long as possible.

RELATED: Multiple Myeloma Relapse — Is There a Go-To Treatment?

However, when the cancer comes back  which it ultimately will patients should know they have options when it comes to treating relapsed multiple myeloma.

Dr. Dickran Kazandjian, a multiple myeloma specialist at Sylvester Comprehensive Cancer Center in Miami, Fla., tells SurvivorNet that "the whole induction (therapy) thing is just a bad nomenclature because in those patients who are not (stem cell) transplant eligible. … We give them similar doses of the same drugs as one would call induction; we give it even longer."

"I think it's natural for us to try to bucket things and that's what we've been doing," he adds, "but I think that's not the way to think about this (treatment for relapsed myeloma patients)."

Drug Regimen for Relapsed Multiple Myeloma

The drugs Dr. Kazandjian is talking about the drugs given during induction therapy and again to patients who experience their first relapse are monoclonal antibody drug daratumumab (brand name: Darzalex), immunotherapy drug lenalidomide (brand name: Revlimid) and steroid dexamethasone (brand names include: Ozurdex, Maxidex and DexPak 6 Day). This combination is commonly referred to as DRD.

"But if they don't respond to that, then you try one of the other therapies," Dr Kazandjian says.

The other drug combinations given to patients during the induction phase are combinations commonly referred to as VRD or KRD (the acronym depends on which drug combination is prescribed), but the standard of case for relapsed myeloma patients is DRD, according to Dr. Kazandjian.

(VRD uses proteasome inhibitor bortezomib (brand name: Velcade), lenalidomide and dexamethasone, while KRD uses proteasome inhibitor carfilzomib (brand name: Kyprolis), lenalidomide and dexamethasone.)

These drugs are given to patients in cycles; there are typically between four and six cycles during the induction phase. Dr. Kazandjian says that in his practice, he gives between eight to 10 cycles in order to achieve the "deepest response" possible. It can last longer during consolidation therapy.

However, for patients who are experiencing their first relapse after having been in remission and on maintenance therapy, these drugs can be given again, and for a longer period of time, as a second line of therapy; this rings especially true for patients who are not eligible for a stem cell transplant. The stem cell transplant is typically done without the myeloma returning, or before it does. But not everyone eligible.

"The second point I wanted to make is the fact that the whole (induction therapy) nomenclature is not so good (because) in all the relapse refractory myeloma the triplet regimen approved for that indication they are the same doses and frequencies as they would be if they were induction," Dr. Kazandjian says.

To figure out which relapsed myeloma treatment is right for you, make sure to consult with your doctor.

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