When Multiple Myeloma Comes Back
- Because multiple myeloma isn’t curable, most people will go through several rounds of remissions and relapses.
- Symptoms of a relapse include bone pain or fatigue.
- Doctors diagnose relapses using blood tests and imaging scans.
- Relapse treatment is personalized based on your preferences, and how you did on your last treatment.
Most people go through several remissions and relapses over the course of their disease, according to the International Myeloma Foundation. But it’s possible to stay in remission for three years or longer before facing your first relapse.
How Do I Know I've Relapsed?
Read More"With relapsed multiple myeloma, often we see that first in the bloodstream," Dr. Krisstina Gowin, assistant professor of medicine at the University of Arizona Cancer Center, tells SurvivorNet.
Relapse Test Results
A complete blood count (CBC) is one test that can detect a relapse. Low levels of red blood cells, white blood cells, or platelets are a sign that multiple myeloma cells have once again started to multiply in your bone marrow.
An abnormal monoclonal antibody spike, or M spike, on a serum protein electrophoresis (SPEP) test also warns of a relapse. Or a test can reveal higher levels of light chains proteins made by plasma cells.
"We’ll see that M spike slowly start to creep up or those light chains slowly start to creep up. We call that a biochemical relapse," Dr. Gowin says.
Minimal Residual Disease Testing
A new way to check for a relapse earlier is with minimal residual disease (MRD) testing. MRD means that a small number of cancer cells are still in your body after treatment. These cells are too small to see, even with a microscope. But they could cause a relapse if you don't have more treatment.
MRD testing analyzes a sample from your bone marrow to look for presence of myeloma cells at a microscopic level with a one in a million sensitivity.
How to Treat a First Relapse
A variety of treatments are available for relapsed multiple myeloma. You could have another stem cell transplant. Or your doctor might prescribe a different combination of medications.
RELATED: Choosing the Best Treatment for Multiple Myeloma Relapse
Treating a multiple myeloma relapse is not one-size-fits-all. "It's a personalized approach," Dr. Gowin says. You and your doctor will talk about how quickly you want to start treatment, and how intense that treatment should be.
When choosing a treatment course, your doctor will consider:
- How well you tolerated induction therapy and your first stem cell transplant
- What side effects you had from during your previous treatment
- How long the effects of your transplant lasted
- Your goals and preferences
Your quality of life is an important part of the treatment decision. Do you want to take an aggressive approach, even if it means you might have unpleasant side effects? Or would you prefer a gentler treatment so you’ll continue to feel good?
Your Choice Matters
You do have a say in which treatment you get. "The way that we manage relapsed refractory multiple myeloma is a very patient-centered approach," Dr. Gowin says.
Talk with your doctor about your risks, the possible side effects of treatment, and what you want to achieve. If you're not happy with your doctor’s recommendation, see another multiple myeloma specialist for a second opinion.
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