Clinical Pathways to Address THE CHALLENGES OF

Treatment Resistance and Relapse in Multiple Myeloma

Executive Summary


Multiple myeloma (MM) is caused by abnormal plasma cell growth in bone marrow, resulting in bone destruction, marrow failure, and adverse blood cell production. The course of MM is characterized by a repeating pattern of remission and relapse as patients cycle through available treatment options. Standardizing treatment options for relapsed/refractory MM poses a challenge to clinical pathway decision-makers, due to the need to individualize treatment decisions for the patient’s specific circumstances. Other challenges to treatment decision-making for relapsed/refractory MM include the disease’s heterogeneity and the proliferation of novel therapeutics and combinations. Economic consequences of the costs associated with maintenance therapy, the use of doublet and triplet regimens, and patients living longer as a result of effective treatments must also be considered. In this report, we review the complex nature of MM treatment, the current landscape of clinical practice guidelines and treatment pathways, and economic considerations for treatment.

Understanding the Different
Phases of Treatment FOR MULTIPLE MYELOMA


Most people in the myeloma field are comfortable with what they're recommending for upfront therapy. It's when relapses happen that there's a lot of choices, and it takes thought about what you're trying to accomplish.

Hematology/bone marrow transplant specialist at the University of Wisconsin School of Medicine and Public Health


The challenges of treatment
resistance and relapse 


There are many theories about why patients with MM relapse and become refractory, and this is a subject of ongoing research.

Hematologist and Oncologist at UH Cleveland Medical Center




With several FDA-approved drugs for MM, some approved in the last few years, plus dozens of combinations, it is difficult for oncologists to keep up with new evidence.


Economic Burden
of Multiple Myeloma


The total costs for MM health care services increased between 2009 and 2014, due to combinations of highly expensive agents, continous treatment with maintenance therapy, and improved survival leading to longer lifespans.


The Future of Relapsed/Refractory
Multiple Myeloma Treatment

In addition to treating patients based on disease aggressiveness, the patient’s years in remission, past experience with toxicity, and reaction to various agents, in the future clinicians may also base treatment on the cancer cell’s genetic mutation type, for which data is fast emerging.