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What Is Refractory Multiple Myeloma?
Refractory multiple myeloma refers to myeloma cancer that does not respond or stops responding to treatment. A doctor may recommend repeating the therapy or trying a combination of them. It's also possible you need an entirely different treatment plan.
Initial treatment for multiple myeloma is effective for some people but may not put the condition into remission for many others. In some cases, the treatment may yield an initial positive response but then stop working. When this happens, the healthcare team may explore other therapies or a combination thereof.
Myeloma may be classified as either relapsed — if treatment initially worked but then stopped responding, or refractory — if the condition starts progressing despite initial treatment.
A doctor may use the term "primary refractory multiple myeloma" if cancer does not have at least a partial response to the initial treatment. They may refer to "double refractory multiple myeloma" if the same happens during treatment with a protease inhibitor and an immunomodulatory agent (two therapies). They may call it "triple-class refractory cancer" if monoclonal antibodies are added to the protocol and this is also not effective.
Experts are not yet clear on why some multiple myeloma diagnoses do not respond to treatment, but changes in the bone marrow and the resilience of multiple myeloma cells are suspected.
The most common symptoms of multiple myeloma fall under the acronym CRAB, which stands for:
A healthcare team will order regular tests to monitor cancer during treatment. They will also order a combination of tests to specifically look for signs of multiple myeloma.
They may perform a bone marrow aspiration and biopsy. During this procedure, a healthcare professional extracts a small section of bone marrow with a thin needle to analyze the cells in a lab.
According to a 2019 literature review, some specific diagnostic tests a healthcare team may order include:
If you need to change treatment strategies or incorporate new ones into the current treatment, it may be helpful to create a list of questions to ask ahead of your medical appointments.
Some questions may include:
If initial treatment is not effective, the healthcare team may recommend a new plan to improve symptoms, prevent organ damage, and treat the cancer.
If you have had a partial response for at least 6 months, the doctor may suggest repeating treatment with the same therapy. They could also consider trying an entirely new treatment and new medications instead of or in addition to the ones you're already taking.
Factors healthcare teams consider when recommending treatment for refractory or relapsed myeloma may include:
Read more about multiple myeloma treatments.
According to the American Cancer Society (ACS), the overall 5-year relative survival rate for a person with multiple myeloma in the United States is 58%.
However, this statistic depends on the stage of multiple myeloma at the time of diagnosis. People who receive a diagnosis early on, when multiple myeloma is localized, typically have higher chances of survival.
The outlook for a person with a refractory multiple myeloma diagnosis is generally more challenging than someone with myeloma where the cancer responds to initial treatment. However, advances in treatment mean that people with refractory multiple myeloma now have more treatment options available.
In a 2021 study reviewing data from the French National Healthcare Database, researchers found that among 12,987 people with relapsed or refractory multiple myeloma, half of the group lived at least 32.4 months after restarting treatment.
At the conclusion of a 2022 research review, researchers predicted that the introduction of new biomarkers to the treatment of multiple myeloma will soon improve relapsed and refractory myeloma survival.
Myeloma is known as refractory if it does not respond to treatment or stops responding to treatment.
If you have refractory myeloma, your doctor may recommend repeating treatment with the same therapy or trying a new management option.
New therapies mean people with refractory myeloma have a higher chance of better outcomes now than they would have in the past.
Monoclonal Gammopathy Of Undetermined Significance (MGUS)
Monoclonal gammopathy of undetermined significance (MGUS) is not cancer. There's a small risk it can become cancer. Out of every 100 people with MGUS, each year, 1 or 2 of them will get cancer from MGUS.
MGUS (pronounced like EM-gus) is when your blood makes an abnormal (not normal) protein called m-protein. It's a blood disorder that often starts in older people after age 50.
You may be at higher risk for MGUS if you:
We do not know what causes MGUS. There may be a link to autoimmune diseases, genetics, or environmental factors.
Like multiple myeloma, MGUS starts in a type of white blood cell called plasma cells. These cells make m-protein. This abnormal protein can build up in your blood and urine.
Blood and urine tests can show if you have MGUS, or show signs it's getting worse. These tests look for how much m-protein is in your blood, and what kind of m-protein you have.
MGUS signs and symptomsPeople with MGUS do not have symptoms or signs of multiple myeloma. Some people feel peripheral neuropathy (peh-RIH-feh-rul noor-AH-puh-thee). This is numbness, tingling, or pain in your hands and feet.
Living with MGUSMGUS can be precancerous, which means it can become cancer. It can be stable for many years, and then turn into another condition. This change happens with very few people. Most people with MGUS never get a more serious condition.
MGUS can turn into multiple myeloma. It also can turn into another blood disease, either:
If you have MGUS, your protein levels should be monitored through regular blood tests. You will not need treatment for MGUS as long as the level of m-protein does not rise.
Your MSK care team can guide your local healthcare provider as they monitor MGUS.
They will watch to see if MGUS becomes another blood disease. If that happens, your MSK doctors can treat plasma cell disorders or multiple myeloma.
Items Tagged With 'multiple Myeloma'
Following the U.S. FDA's expansion of competing BCMA-targeting CAR T therapy Abecma (idecabtagene vicleucel) to include third-line and later treatment in multiple myeloma (MM) patients, the agency cleared Carvykti (ciltacabtagene autoleucel) from Legend Biotech Corp. And Johnson & Johnson's Janssen unit for use in MM patients as early as second-line treatment. The label, which RBC Capital Markets analyst Leonid Timashev called a "best-case scenario," includes no notable updates to the black box warning and should help accelerate and expand Carvykti's update in the U.S., with 2024 revenues expected to top $950 million.
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