Multiple Myeloma, a cancer of the white blood cells, results in the accumulation of plasma cells in the bone marrow. Plasma cells are crucial for the immune system as they produce antibodies to fight infections. However, the condition causes overcrowding of plasma cells that produce abnormal proteins, resulting in complications.

Relapse refers to the recurrence of a condition that was previously treated. Relapsed multiple myeloma refers to an imminent threat of this cancer developing in the same or different areas of the body.

Early relapsed multiple myeloma
An early relapse is possible soon after the first line of therapy. The number of relapses may vary from person to person. A series of tests including a blood test, urine sampling, bone evaluation, and bone marrow analysis are done to confirm the condition. The recurrence of the condition can be classified as early relapse and late relapse. The treatment may depend on the severity of the symptoms; this also determines one or multiple combinations of the developing condition.

Common early relapsed multiple myeloma medications

• Proteasome inhibitors
  Multiple myeloma results in the generation of M-proteins that are not useful for the body. However, proteasome inhibitors prevent the cells from absorbing the proteins as a method of disposal to control excess production. The medication lets the proteins build up internally to kill the myeloma cells, curbing the mutation at its source.
• Immunomodulatory medications
  The main purpose of these agents is to boost the immune system to defend the body from infections. Immunomodulatory medications also cut off the blood supply to the source of cancer cells and starve it, preventing the cells from mutating.
• Monoclonal antibodies
  Antibodies circulate throughout the body and stick to antigens. It enables the immune system to track and destroy the cells containing antigens. Monoclonal antibodies attach themselves to the already-affected myeloma cells. The immune system then targets the infected cells only by identifying the antigens. There are three predominant types including naked monoclonal antibodies, conjugated monoclonal antibodies, and bispecific monoclonal antibodies.

Late relapsed multiple myeloma
The course of medication for the treatment of a subsequent relapse or late relapse myeloma will be the same as an early relapse. The dosage, frequency, and method of administering, however, may differ depending on the severity of the condition. As the biology of these cancer cells changes over the course of time, they also become difficult to treat. The affected people often suffer from multiple relapses throughout the course of the condition.

Most doctors will continue with the combined course of proteasome inhibitors, immunomodulatory medications, and monoclonal antibodies to stop the condition from worsening. However, many patients become resistant to therapies and often choose to enroll in clinical trials for cancer treatments. The cost of enrolling for a clinical trial is also significantly less in comparison to private treatments.

Common late relapsed multiple myeloma medications

• Chemotherapy
  Chemotherapy is a treatment option that involves the use of medication to control the overgrowth and destroy cancer cells causing myeloma. The medication can be ingested orally or can be injected through a vein or muscle in the body. Sometimes, with the cancer cells multiplying rapidly, the body’s immune system is unable to cope with the cell mutation; this is when chemotherapy is often combined with corticosteroids and immune-modulating agents. One can experience side effects including hair loss, mouth sores, loss of appetite, nausea, vomiting, and low blood counts, resulting in unbalanced levels of blood cells. It can further cause infection and bruising due to a low count of blood platelets and anemia. One must consult with a specialist to know more about chemotherapy for relapsed multiple myeloma.
• Corticosteroids
  Relapsed multiple myeloma can be treated with corticosteroids that counter inflammation. Corticosteroids also help control the side effects caused due to chemotherapy, including nausea and vomiting. Specialists don’t recommend the use of corticosteroids for a longer duration as it suppresses the immune system and increases the risk of infections. Common side effects of prolonged use of corticosteroids also include high blood sugar, increased appetite, insomnia, and mood swings.

Post-treatment care
In many cases, the treatment can completely remove and destroy cancer cells. However, patients with multiple myeloma need to be extra careful as the condition has a good chance of relapsing. Follow-up care is of utmost importance for all. One must make regular appointments to conduct tests that can also detect a relapse.