Treatment if myeloma comes back
If your myeloma comes back, it may be possible to repeat the treatment you originally had to control it, depending on what the treatment was and how long your remission lasted.
If this isn’t possible, there are usually other treatment options, which your doctor will discuss with you.
Treatments that may be considered are:
high-dose treatment with stem cell support
A combination of drugs that is sometimes used is DT-PACE, which includes dexamethasone, thalidomide, cisplatin, doxorubicin, cyclophosphamide and etoposide.
The drug lenalidomide (Revlimid®) has been shown to help control myeloma that has come back. It’s one of a group of drugs known as IMiDs® that work in a similar way to thalidomide.
Lenalidomide is a capsule taken once a day for three weeks, followed by one week off.
The main side effects of lenalidomide are an increased risk of infection (due to a low number of white blood cells), anaemia (due to a low number of red blood cells), and possible bruising and bleeding (due to a low platelet count). Rare side effects include constipation, a rash and sleepiness. When taken with the steroid dexamethasone, there is an increased risk of blood clots in your legs. You may be given blood-thinning medicines to reduce this risk.
The National Institute for Health and Clinical Excellence (NICE) gives advice about which new treatments should be available on the NHS in England and Wales. The equivalent body in Scotland is the Scottish Medicines Consortium (SMC).
NICE and the SMC have approved the use of lenalidomide in combination with dexamethasone in people whose myeloma has come back and who’ve already had at least two different courses of treatment.