What Is Multiple Myeloma Relapse? Everything to Know

Medically Reviewed By Julie Scott, DNP, ANP-BC, AOCNP
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Multiple myeloma relapse occurs when the cancer returns after an initial period of improvement. To control the cancer’s growth and spread, treatment needs to restart or change. Multiple myeloma is a type of white blood cell cancer that affects the bones and bone marrow. The cancer is rare and occurs mostly in people 70 years and older.

Treatments can help manage it, but relapse can occur during treatment or shortly after in many people. 

This article explores multiple myeloma relapse, including the symptoms, frequency, and cause. Learn about the treatments for relapse, when to contact a doctor, and how your doctor will check for relapse. 

What are the symptoms of a multiple myeloma relapse?

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A person undergoing treatment for multiple myeloma or who recently finished treatment may experience relapse.

Some people have no symptoms while others may have an increase in symptoms. According to studies, these may include:

  • bone pain
  • fatigue
  • high calcium levels
  • decreased kidney function
  • frequent infections
  • frequent bruising or bleeding
  • breathlessness

Symptoms for multiple myeloma can vary and some may alter in severity. 

Learn about the symptoms of multiple myeloma.

How frequently does multiple myeloma relapse occur?

Multiple myeloma is not a curable condition. With treatment, the cancer stabilizes, followed by times of relapsing or increasing symptoms. 

People with multiple myeloma may experience one or more relapses. Typically, after initial treatment, cancer remains in remission for 2–3 years before the first relapse.

Genetics, treatment history, and stage of diagnosis play a role in determining the rate of relapse

In addition, the frequency of myeloma relapses can change, making it difficult to predict how often they may occur.

Watching for signs of relapse allows your doctor to adjust treatment as needed.

What causes multiple myeloma relapse?

Treatments focus on decreasing the number of cancer cells. However, some cancer cells may remain, or the cancer can become resistant to some treatment.

However, people with multiple myeloma are now living longer because of new treatments. 

Learning how to live well with the condition and being able to change treatment based on your symptoms or lab results is key.

Learn about cancer recurrence.

What are the treatments for multiple myeloma relapse?

Doctors call the first 1–3 relapses “early relapse.” As time progresses and the condition becomes more resistant, they refer to them as subsequent relapses.

Treatment for early relapse differs from subsequent relapse. 

Early relapse

If you have already had an autologous stem cell transplant followed by remission that lasted 2–3 years, your doctor might suggest a second transplant when you first experience a relapse. 

If you had a different treatment that put you into remission for 6 months to 1 year, the first line of treatment for relapse would be to consider reusing that same therapy. 

People taking a maintenance therapy with lenalidomide (Revlimid) and experiencing a nonaggressive relapse may reach remission by adding medication. Either elotuzumab (Empliciti) and dexamethasone or ixazomib (Ninlaro) and dexamethasone may be added to their medication regimen. 

Doctors sometimes use a combination of medications to treat relapse. Effective combination treatments come from three major classes of drugs:

  • immunomodulatory drugs (IMiDs)
  • proteasome inhibitors (PIs)
  • monoclonal antibodies (mAbs) 

Subsequent relapse

Myeloma can become more resistant and complex over time. This may require a change in the types of treatments you need to keep your condition in remission. There are many treatment guidelines approved to treat subsequent relapse. 

The medications typically come from the same classes of drugs used during early relapse. However, the combinations are different. There are also immunotherapy and new clinical trial approaches your doctor may want to discuss. 

Learn more about the treatments for multiple myeloma.

When should I contact a doctor?

If you have multiple myeloma, it is important to expect a relapse. Understand the signs and symptoms of a possible relapse and report them immediately to your medical professional. 

Let your doctor know if you experience:

They will be able to run some tests to check for relapse and suggest treatment to get you back to being more stable.

Sometimes there are no symptoms of relapse. Your doctor may see some abnormal lab levels or images during routine checks. These can indicate you are experiencing a relapse.

Our multiple myeloma appointment guide can help you to prepare for your appointment.

How do doctors detect multiple myeloma relapse?

Several tests can check for relapse, including:

  • blood tests
  • urine analysis
  • bone evaluation through imaging studies
  • bone marrow testing through bone marrow biopsy

The International Myeloma Foundation defines specific criteria for relapse. For a doctor to confirm relapse of multiple myeloma, a person must have one or more of the following indications:

  • definite increase in the size of plasma cell tumors or bone lesions
  • increased calcium levels of greater than 11 milligrams per deciliter (mg/dL)
  • decrease in hemoglobin level equal to or less than 2 grams per deciliter (g/dL)
  • increase in serum creatinine by 2 mg/dL or more from the start of the therapy
  • thickening of the blood related to serum protein
  • an increase of at least 0.5 g/dL in serum M protein
  • an increased difference between abnormal and normal free light chain levels of more than 10 mg/dL
  • an increase of at least 200 mg per 24 hours in urine M protein

Find out about how doctors diagnose multiple myeloma.

Learn more

Summary

Relapses are a reality for most people with multiple myeloma. This means there is a return of cancer after a time of stability. 

Sometimes a person may not have symptoms of relapse. In some cases, the doctor may detect it during lab tests or imaging studies. 

Relapses occur when cancer cells not killed by treatment start to grow or when they become resistant to a certain type of treatment. However, there are many treatments available to try and put the cancer back into remission. 

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Medical Reviewer: Julie Scott, DNP, ANP-BC, AOCNP
Last Review Date: 2023 Jan 24
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