Multiple Myeloma Relapse: Monitoring and Treatment Insights from Dr Daryl Tan

 

Multiple Myeloma Relapse: Monitoring and Treatment Insights from Dr Daryl Tan

Multiple myeloma relapse occurs when the disease becomes active again after a period of remission. Because multiple myeloma remains incurable, patients may experience repeated cycles of remission and relapse and require different treatments over time.

Approximately 100 to 120 new cases of multiple myeloma are diagnosed in Singapore each year. Although there is currently no cure, newer treatments can control the disease, extend remission and reduce its impact on patients’ daily lives.

What Is Multiple Myeloma?

Multiple myeloma is a blood cancer that begins in plasma cells within the bone marrow. It is not a solid tumour.

Dr Daryl Tan explained that abnormal plasma cells multiply in the bone marrow and take up the space needed for healthy blood cells to develop. This suppresses normal blood cell production and damages bone structure.

The disease can lead to:

• Bone pain
• Bone fractures
• Anaemia
• Recurrent infections
• Kidney damage

Common symptoms include pain in the back or ribs, persistent fatigue, weakness and frequent infections. Symptoms may not be obvious during the early stages, and can therefore be overlooked.

What Are the Risk Factors for Multiple Myeloma?

Risk factors associated with multiple myeloma include:

• Older age, usually above 60
• Being male
• Being of African ancestry
• A history of monoclonal gammopathy of undetermined significance
• Obesity
• A family history of multiple myeloma
• Prolonged exposure to radiation
• Prolonged exposure to chemicals such as benzene or pesticides

Monoclonal gammopathy of undetermined significance, also known as MGUS, is a non-cancerous condition in which an abnormal protein is found in the blood. In some patients, it can later progress to multiple myeloma.

However, Dr Daryl Tan emphasised that the exact cause of multiple myeloma cannot be identified in most cases.

Why Does Multiple Myeloma Relapse?

Multiple myeloma is often described as a relapsing-remitting cancer.

During remission, the disease is under control. During relapse, it becomes active again. Patients may move between these periods several times and require multiple courses of treatment.

In the past, when treatment options were more limited, many patients experienced their first relapse approximately three to four years after receiving first-line treatment.

Dr Daryl Tan shared that advances in treatment have extended the typical time to a first relapse to approximately five to seven years.

However, the characteristics of the disease differ between patients.

“Every patient’s myeloma has different characteristics,” Dr Daryl Tan explained.

In patients with high-risk myeloma, cancer cells may carry aggressive mutations, grow more rapidly and respond less effectively to standard treatment.

What Is an Early Multiple Myeloma Relapse?

An early multiple myeloma relapse occurs when the disease returns approximately 12 to 18 months after the first treatment.

According to Dr Daryl Tan, this usually indicates that the disease is more aggressive or has developed resistance to treatment. It may also be associated with high-risk biological factors.

Each relapse generally requires the treatment plan to be reviewed and adjusted. The next treatment depends on the characteristics of the disease and how the patient responded to previous treatment.

How Can Multiple Myeloma Relapse Be Detected?

Regular follow-up appointments and blood tests are important throughout the course of multiple myeloma.

Dr Daryl Tan explained that regular monitoring can often identify signs of relapse before symptoms appear. This allows the patient’s medical team to review the disease and adjust the treatment plan when necessary.

Patients should contact their myeloma specialist promptly if they develop:

• Worsening bone pain
• Abnormal kidney function
• Extreme fatigue caused by severe anaemia

When these problems develop, the disease may already have become more active.

How Is Multiple Myeloma Treatment Planned?

Multiple myeloma treatment must be tailored to the individual patient.

The treatment plan is determined by factors such as:

• The patient’s age
• Overall health
• The risk classification of the disease

Treatment generally begins with induction therapy to reduce the number of cancer cells. This is followed by maintenance treatment to keep the disease under control and delay relapse.

The main treatments for multiple myeloma include:

• Proteasome inhibitors
• Immunomodulatory medicines
• Monoclonal antibodies
• Steroids
• Stem cell transplantation for suitable patients

Because multiple myeloma is a chronic disease, treatment is often ongoing.

What Treatments Are Available After Multiple Myeloma Relapse?

More targeted immune-based treatments have become available for patients with relapsed multiple myeloma.

Dr Daryl Tan highlighted several treatment approaches:

• Antibody-drug conjugates
• Bispecific antibodies
• Chimeric antigen receptor T-cell therapy, also known as CAR-T therapy

Doctors have also started using some highly effective medicines at earlier stages of the disease. These treatments were previously reserved for patients with advanced or repeatedly relapsed multiple myeloma.

Using these medicines earlier has improved treatment outcomes and extended survival.

How Has Modern Treatment Changed Daily Life?

Traditional chemotherapy often required hospitalisation and was commonly associated with hair loss, severe nausea and vomiting.

Many modern targeted treatments can be administered in an outpatient setting. Patients may take oral medicines and receive injections every one to two weeks.

These treatments are generally better tolerated and have less impact on daily life than traditional chemotherapy.

However, newer medicines can still cause side effects, including:

• Skin rashes
• Numbness in the hands and feet
• Drowsiness
• Changes in vision
• Infections
• Fever

Continued monitoring remains important throughout treatment.

How Has Multiple Myeloma Survival Improved?

Advances in targeted medicines, immunotherapies and antibody-based treatments have improved multiple myeloma outcomes.

Dr Daryl Tan shared that 20 years ago, the average survival period for patients with multiple myeloma was approximately four to five years. Today, it has increased to about 12 to 15 years.

Although relapse remains part of the disease course for many patients, newer treatments can control multiple myeloma for longer and extend periods of remission.

Dr Daryl Tan encouraged patients not to lose hope when the disease relapses.