Despite the best efforts of oncologists to treat multiple myeloma, it can come back, or relapse. This is because not every myeloma cell in your body is exactly the same, and so not all will respond in equal ways to treatment. Some myeloma cells start out with a set of mutations that can resist treatments and are more likely to relapse. And, other myeloma cells develop mutations as a result of treatment. Unfortunately the myeloma cells that can’t be killed do come back stronger.
What are your options for relapsed myeloma? The good news is that with so many different drugs available to treat relapsed myeloma, there are plenty of combinations that may prove effective. Here’s a brief overview of some of the drugs available to treat relapsed myeloma:
- Alkeran: This is a chemotherapy. It interferes with the creation of DNA, a vital component in the ability of myeloma cells to divide and grow. It is effective in killing myeloma, but also can damage healthy cells, leading to the side effects typical of chemotherapy, like hair loss, low blood count, nasuea, fever, etc.
- Velcade (bortezomib) and Kyprolis (carfilzomib): These are drugs that disrupt the mechanism by which cancer cells break down proteins. This build-up of protein within the cell eventually causes the cells to die.
- Revlimid (lenalidomide), Immunoprin (thalidomide), and Pomalyst (Pomalidomide): These are known as immunomodulatory drugs. In other words, they activate your immune system to target cancer cells and kill them.
- Dexamethasone: This is a steroid drug that prevents inflammation and associated pain from myeloma, and it can even help kill myeloma cells at high doses.
- Selinexor: This is a fairly new class of drugs which stops the ability of myeloma cells to get rid of tumor suppressor proteins, the proteins inside cancerous cells, which are experts at preventing tumors.
- Dara (Daratumumab): This is known as an immunotherapy. More specifically, it is a monoclonal antibody that ‘tags’ cancer cells for recognition by the immune system.
And, if patients are not refractory to, or resistant to, lenalidomide, then the best combination for treating relapsed multiple myeloma is a combination therapy consisting of lenalidomide, daratumumab, and dexamethasone. Dr. Vincent Rajkumar, medical oncologist at the Mayo Clinic says that “this strategy of using a monoclonal antibody, and by combining with other effective agents, has proven to be remarkably successful in multiple myeloma.” In fact, in a recent trial studying the effects of this combination therapy, patients who took these three drugs were able to extend their life by an average of almost two years compared to those that did not receive the treatment. Like any other treatment for cancer, these drugs to have some side effects including:
- Fever/chills: this is caused by the infusion of daratumumab via intravenous fluid, IV.
- Blood clots: these are caused by lenalidomide, and patients are given aspirin to help break up clots.
- Weight gain: these are caused by dexamethasone, a steroid.
- Infections: since steroids suppress your immune system, dexamethasone puts you at a higher risk of infection.
In sum, relapsed myeloma is more aggressive than ever. Fortunately current treatments may extend your life more than has ever been possible.