Optimizing Care for Patients with Relapsed and/or Refractory Multiple Myeloma

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It is estimated that this year alone, approximately 21,000 individuals in the United States will be diagnosed with multiple myeloma (MM), and more than 10,000 deaths will be attributed to the disease.1 Response rates and survival have improved considerably over the past several decades, due in large part to the use of high-dose chemotherapy, stem cell transplantation, and the development and approval of the targeted agents thalidomide, lenalidomide, and bortezomib.2 Although these advances have resulted in prolonged remissions and better quality of life, virtually all patients with MM relapse or become refractory to treatment and eventually, die from the disease.

Some patients with myeloma respond well to initial therapy but experience disease progression in the absence of treatment. These individuals are referred to as having relapsed MM. Others do not respond to initial therapy, and have what is known as primary refractory MM. There is also a subset of patients who have relapsed and refractory MM, defined by disease progression during a specific therapy or within 60 days of their last treatment.3 The safe and effective treatment of relapsed and/or refractory MM remains an area of intense focus for investigators and clinicians, and new agents for use in the lateline setting continue to be evaluated in clinical trials.

On January 20-21, 2012, nurses and pharmacists from around the country gathered in Houston, Texas to discuss current challenges and recent advances in the late-line setting for myeloma. The following articles provide perspectives on important issues that were discussed during this roundtable.

The management of disease- and treatment-related complications, both in clinical trials and in everyday practice, was considered a high priority by participants, and several discussions focused on strategies to help patients with relapsed and/or refractory myeloma remain on therapy. In addition, both nurses and pharmacists alike thought there was a need for more information related to the optimal use of investigational agents, including treatment-related adverse events, potential drug-drug interactions, administration guidelines, methods of reconstitution, and avenues for providing education to healthcare professionals and patients.

In light of the rapidly evolving therapeutic landscape for relapsed and refractory myeloma, and the special needs of this difficult-to-treat population, the sharing of knowledge, concerns, and insight among nursing and pharmacy professionals in the field remains essential for ensuring optimal patient care.


  1. American Cancer Society. Cancer Facts & Figures 2012. Atlanta, GA: American Cancer Society; 2012.
  2. Kumar SK, Rajkumar SV, Dispenzieri A, et al. Improved survival in multiple myeloma and the impact of novel therapies. Blood. 2008; 111:2516-2520.
  3. Lonial S. Relapsed multiple myeloma. Hema - tology. 2010;303-309.
Last modified: July 22, 2021