Treatments for relapsed or refractory multiple myeloma

Relapsed multiple myeloma means that the cancer has come back after it has been treated.

Refractory multiple myeloma means that the cancer did not respond to treatment.

Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan. What you want will also be important when planning treatment.

Targeted therapy uses drugs to target specific molecules (such as proteins) on cancer cells or inside them to stop the growth and spread of cancer. It is usually combined with chemotherapy drugs or supportive therapy drugs or both. The types of targeted therapy used for relapsed or refractory multiple myeloma may depend on how well these drugs worked in previous treatments.

The following targeted therapy combinations may be offered for relapsed or refractory multiple myeloma:

• DRd – daratumumab (Darzalex), lenalidomide (Revlimid) and low-dose dexamethasone
• Isa-Kd – isatuximab (Sarclisa), carfilzomib (Kyprolis) and low-dose dexamethasone
• DVd – daratumumab, bortezomib (Velcade) and low-dose dexamethasone
• Vd – bortezomib and low-dose dexamethasone
• Isa-PD – isatuximab, pomalidomide (Pomalyst) and dexamethasone
• KRd – carfilzomib, lenalidomide and low-dose dexamethasone
• KPD – carfilzomib, pomalidomide and dexamethasone
• Kd – carfilzomib and low-dose dexamethasone
• DKd – daratumumab, carfilzomib and low-dose dexamethasone
• XVd – selinexor (Xpovio), bortezomib and low-dose dexamethasone
• KCd – carfilzomib, cyclophosphamide and low-dose dexamethasone
• IRd – ixazomib (Ninlaro), lenalidomide and low-dose dexamethasone
• SVd – selinexor, bortezomib and low-dose dexamethasone
• Pd – pomalidomide and low-dose dexamethasone
• CyBorD – cyclophosphamide, bortezomib and dexamethasone
• Rd – lenalidomide and low-dose dexamethasone
• PVd – pomalidomide, bortezomib and low-dose dexamethasone
• PCP – pomalidomide, cyclophosphamide and prednisone
• DPd – daratumumab, pomalidomide and low-dose dexamethasone
• Dara/Dex – daratumumab and dexamethasone
• Talquetamab (Talvey)

These targeted therapy drugs may not be covered by all provincial and territorial health plans.

Find out more about targeted therapy for multiple myeloma.

A stem cell transplant replaces stem cells. The type of stem cell transplant usually done for relapsed or refractory multiple myeloma is an autologous stem cell transplant. An autologous stem cell transplant is when stem cells are collected from your own blood or bone marrow rather than from a donor.

A stem cell transplant is a treatment option if you're able to have a stem cell transplant (called transplant eligible multiple myeloma) and one of the following is true:

• You didn't have a stem cell transplant as a first-line therapy.
• There was a remission following the first stem cell transplant of 4 years or more.

Find out more about stem cell transplant for multiple myeloma.

Watchful waiting means that your healthcare team watches the cancer closely rather than giving other treatment right away.

It may be used for relapsed or refractory multiple myeloma that is progressing slowly or if you aren't experiencing any symptoms. Other treatment is given when you develop symptoms or the cancer changes.

Find out more about watchful waiting for multiple myeloma.

Immunotherapy helps to strengthen or restore the immune system's ability to fight cancer.

The following immunotherapy drugs may be offered for relapsed or refractory multiple myeloma:

• ciltacabtagene autoleucel (Carvykti)
• teclistamab (Tecvayli)
• elranatamab (Elrexfio)

These immunotherapy drugs may not be available in all areas or covered by all provincial or territorial health plans.

Find out more about immunotherapy for multiple myeloma.

External beam radiation therapy may be used to relieve pain or control the symptoms of advanced multiple myeloma (called palliative radiation therapy).

Find out more about radiation therapy for multiple myeloma.

Supportive therapy is used to prevent or control health problems and complications related to multiple myeloma. You may have the following supportive therapy drugs for relapsed or refractory multiple myeloma.

Drugs to slow down bone loss– Everyone with multiple myeloma is usually given either a bisphosphonate, such as zoledronic acid (Aclasta, Zometa) or pamidronate, or a drug called denosumab (Prolia, Xgeva and biosimilars) . These drugs help to slow down bone loss and keep your bones strong.

Drugs to prevent blood clots– Lenalidomide and pomalidomide can increase your risk of serious blood clots. You will be given drugs that help prevent blood clots, such as acetylsalicylic acid (ASA, Aspirin), heparin or warfarin, if your treatment includes lenalidomide or pomalidomide.

Drugs to prevent infection– Stem cell transplants and other drugs used to treat multiple myeloma increase your risk of infection. Antibiotics are often given to help prevent infection.

Find out more about supportive therapy for multiple myeloma.

Talk to your doctor about clinical trials open to people with multiple myeloma in Canada. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.

You may want to consider a type of care to make you feel better without treating the cancer itself. This may be because the cancer treatments don't work anymore, they're not likely to improve your condition or they may cause side effects that are hard to cope with. There may also be other reasons why you can't have or don't want cancer treatment.

Talk to your healthcare team. They can help you choose care and treatment for advanced cancer.