Understanding Relapsed and Refractory Multiple Myeloma

Patients with relapsed multiple myeloma have experienced a return of disease activity after a period of response. Refractory multiple myeloma refers to cancer that fails to respond or stops responding to a treatment that previously worked. The treatment landscape for RRMM is shaped by prior therapies, drug resistance, genetic risk factors, and the patient’s overall health.


Current Drug Options for RRMM

1. Proteasome Inhibitors (PIs)

Drugs like carfilzomib and ixazomib are commonly used in combination with other agents to target protein degradation pathways in myeloma cells.

2. Immunomodulatory Drugs (IMiDs)

Agents such as lenalidomide and pomalidomide remain vital, especially in combination therapies, though resistance is a growing challenge in relapsed cases.

3. Monoclonal Antibodies

Drugs like daratumumab (anti-CD38) and elotuzumab (anti-SLAMF7) have shown strong outcomes in RRMM when used alongside other treatments.

Learn more about CD38-targeting monoclonal antibodies in myeloma care.


New and Emerging Therapies

CAR T-Cell Therapy

One of the most promising treatments for relapsed and refractory multiple myeloma is chimeric antigen receptor (CAR) T-cell therapy. This immunotherapy uses engineered patient T cells to attack myeloma cells. Agents like idecabtagene vicleucel and ciltacabtagene autoleucel are FDA-approved options with growing real-world data.

Bispecific Antibodies

These drugs simultaneously bind to cancer cells and immune cells, triggering a targeted immune response.Several bispecifics targeting BCMA or GPRC5D are under accelerated approval or late-stage trials.

Find current clinical trials for bispecific antibodies in RRMM.


Combination Strategies and Sequencing

Given the complexity of RRMM, sequencing and combining drugs is essential. Common regimens include:



  • Daratumumab + Carfilzomib + Dexamethasone




  • Pomalidomide + Bortezomib + Dexamethasone




  • Selinexor-based combinations



Therapy selection often depends on prior exposure, tolerance, and resistance. Physicians monitor minimal residual disease (MRD) status to adjust plans.


Clinical Trials and Access to Innovation

Many patients with relapsed or refractory multiple myeloma are now enrolling in clinical trials to gain early access to investigational drugs. Trials are focused on next-generation CAR T therapies, bispecifics, and small molecules targeting novel mechanisms.

Explore clinical trials for relapsed and refractory multiple myeloma in the U.S.


Supportive Care and Quality of Life

Supportive care remains critical in RRMM treatment. Patients often face:



  • Fatigue




  • Bone pain




  • Anemia




  • Risk of infections



Use of growth factors, pain management, and bone-strengthening agents (like zoledronic acid) help improve overall well-being during aggressive therapy cycles.


Final Thoughts

The treatment landscape for relapsed and refractory multiple myeloma continues to advance rapidly, with options ranging from standard drug combinations to cutting-edge cell therapies. For patients navigating RRMM, the key lies in individualized care plans, continuous monitoring, and consideration of clinical trials for long-term control.