How Do I Best Evaluate Myeloma Treatment Options After Relapse?

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Jack Aiello:

So, Dr. Kaufman, we talked a little bit about this, but these days it's not—it's pretty typical for a patient to have induction therapy of RVD.  They may or may not go through a transplant.  They probably will go on some type of maintenance, and then they relapse.  How do you go about deciding what treatment is next for them?  

Dr. Kaufman:

Yeah, there are a lot of things that go into deciding next treatments.  We look at what the patient was treated with.  Is the patient on maintenance?  How the patient tolerated that initial therapy, and what is the nature of the relapse?  There are some patients whose relapse is very slow.  We see the numbers, they rise, there's no symptoms at all, and in that group of patients we can just choose to keep an eye on things.  And then there's other groups of patients who when they relapse are very sick, and so we have to be very aggressive.  And then the majority of patients are somewhere in that range.   

As you mentioned before, the good news is that we have a lot of treatment options.  The challenge, if I remember this correctly, I think there are seven therapies, groups of therapies, seven regimens that are currently approved for use as treatment in the first relapse, when the myeloma comes back. And so we've spent a lot of time and energy within our group trying to place the right treatment in the right patient population at that time.  

Jack Aiello:

Dr. Fonseca, if a patient did well on induction therapy and did well on transplant or not and okay on maintenance until they relapse, will you sometimes put them on the exactly same treatment they had in induction therapy?   

Dr. Fonseca:

You know, it is possible if there is a very long period of time between the time they completed therapy and the time we're seeing cells emerge again.  Particularly if someone was on an oral regimen it's very appealing to think about going back into that.  However, we have to balance that with doing what we would call best practices, so if someone is experiencing a relapse and, you know, the disease appears to be aggressive or someone is developing anemia or a knee bone lesion, I think it's better to give the benefit of the doubt to a better treatment in a that regard.  So more often than not we would go with one of those three?drug combinations, what are called a triplet, in that situation. But there are some situations where you might restart what was done in the past if there's a long period between completion of therapy and relapse.  

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.