WHAT IS A MULTIPLE MYELOMA RELAPSE?

What is a relapse in multiple myeloma?

Although treatment can reduce the number of myeloma cells in the body, there may be cells that remain or become resistant to treatment. Over time, these cells may start to multiply. After a period of improvement following treatment, multiple myeloma will return for most people, which is known as a relapse. A relapse may mean that you and your healthcare provider should consider a new treatment.

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How often can multiple myeloma relapse?

Almost all people with multiple myeloma will experience a relapse and some may experience several relapses over time. If you have multiple myeloma, it is likely it will come back, even after successful treatment. When multiple myeloma relapses, lab tests will show increasing levels of an abnormal antibody called M protein.

Graph outlining a multiple myeloma journey.

A multiple myeloma relapse can occur with or without symptoms

When multiple myeloma returns, the experience can be different for every person. Some people have symptoms when multiple myeloma relapses, while others may not. Some people only learn that a treatment change may be needed because of certain changes in lab results, such as increasing levels of M protein.

When multiple myeloma relapses, you may hear different terms used to describe the relapse:

Progressive disease: Multiple myeloma that has progressed as measured by serum or urine laboratory tests or by imaging studies.

Refractory disease: When multiple myeloma doesn’t initially respond or stops responding to a certain treatment, it is known as refractory multiple myeloma. This is also known as treatment resistance.

Primary refractory disease: Multiple myeloma that does not respond to initial treatment.

Talk to your healthcare provider about your M proteins levels and how you're feeling—be sure to communicate any changes, even small ones. Symptoms can be subtle at
first and it can be hard to know if symptoms are related to your multiple myeloma relapsing or another condition.

What are the signs that my multiple myeloma has relapsed?

Flip the cards over to learn about the types of multiple myeloma relapses.

LIMITED OR NO SYMPTOMS AND INCREASING M PROTEIN LEVELS
(Also called an M spike)

This type of relapse is called an indolent relapse or biochemical relapse

INDOLENT RELAPSES HAVE LIMITED OR NO SYMPTOMS

No obvious multiple myeloma symptoms (mild symptoms may not be noticeable)
No organ problems
M spike identified on lab tests

SYMPTOMS AND INCREASING M PROTEIN LEVELS
(Also called an M spike)

This type of relapse is known as a symptomatic relapse or clinical relapse

SYMPTOMATIC RELAPSES HAVE OBVIOUS SYMPTOMS

Multiple myelom a symptoms such as fatigue, shortness of breath, or bone pain
Symptoms may range from mild to severe and may change over time
Organ problems may occur (such as kidney problems)

Tracking M protein is a way of monitoring your multiple myeloma

Lab tests can help monitor your multiple myeloma and signal the first sign of a relapse

An increase of M protein in your blood is a sign that your multiple myeloma may have relapsed. The amount of M protein is measured using a multiple myeloma test, the M spike lab test. It is called an M spike when M protein is detected in your blood or urine. Some people have myeloma cells that produce very little M protein, whereas others produce a lot of M protein, so it’s important to track your M protein levels individually over time.

Treatment options for relapsed multiple myeloma

There are many options for treating relapsed multiple myeloma. Several factors can help determine the next treatment that’s right for you including which prior treatments you’ve had and how long your multiple myeloma responded to those treatments.

Treatment options for relapsed multiple myeloma include chemotherapy, targeted therapies like proteasome inhibitors, monoclonal antibodies, hematopoietic stem cell transplantation (HSCT) (only for eligible patients who did not receive HSCT as part of their initial treatment), or a clinical trial. These therapies may be given in combination.

Early treatment can make a difference

In a study of patients experiencing a first multiple myeloma relapse, early treatment resulted in better outcomes for patients whose M protein levels were increasing and who weren’t experiencing any symptoms. Even before your multiple myeloma relapses, you can start working with your doctor to determine the next treatment that's right for you. The path a treatment journey takes will be different for every person, but you are not alone. There are resources and support groups that can help.

Results with NINLARO

Explore study data for NINLARO in combination with lenalidomide + dexamethasone.

STUDY RESULTS

Lab test tracker

Details on common multiple myeloma tests and a place to record your values.

Track Lab Results

Side effects with NINLARO

Get details about potential side effects.

Discover Side Effects

IMPORTANT SAFETY INFORMATION FOR NINLARO^® (ixazomib)

NINLARO may cause serious side effects, including:

Low platelet counts (thrombocytopenia) are common with NINLARO and can sometimes be serious. You may need platelet transfusions if your counts are too low. Tell your healthcare provider if you have any signs of low platelet counts, including bleeding and easy bruising.

Stomach and intestinal (gastrointestinal) problems. Diarrhea, constipation, nausea, and vomiting are common with NINLARO and can sometimes be severe. Call your healthcare provider if you get any of these symptoms and they do not go away during treatment with NINLARO. Your healthcare provider may prescribe medicine to help treat your symptoms.

Nerve problems are common with NINLARO and may also be severe. Tell your healthcare provider if you get any new or worsening symptoms including: tingling, numbness, pain, a burning feeling in your feet or hands, or weakness in your arms or legs.

Swelling is common with NINLARO and can sometimes be severe. Tell your healthcare provider if you develop swelling in your face, arms, hands, legs, ankles, or feet, or if you gain weight from swelling.

Skin reactions. Rashes are common with NINLARO. NINLARO can cause rashes and other skin reactions that can be serious and can lead to death. Tell your healthcare provider right away if you get a new or worsening rash, severe blistering or peeling of the skin, or mouth sores.

Thrombotic microangiopathy (TMA). This is a condition involving blood clots and injury to small blood vessels that may cause harm to your kidneys, brain, and other organs, and may lead to death. Get medical help right away if you get any of the following signs or symptoms during treatment with NINLARO: fever, bruising, nose bleeds, tiredness, or decreased urination.

Liver problems. Tell your healthcare provider if you get these signs of a liver problem: yellowing of your skin or the whites of your eyes; pain in your right upper stomach-area (abdomen).

Other common side effects of NINLARO include low white blood cell counts (neutropenia) and bronchitis.

Tell your healthcare provider if you get new or worsening signs or symptoms of the following during treatment with NINLARO:

skin rash and pain (shingles) due to reactivation of the chicken pox virus (herpes zoster)

blurred vision or other changes in your vision, dry eye, and pink eye (conjunctivitis)

These are not all the possible side effects of NINLARO. Talk to your healthcare provider for medical advice about side effects. You may report side effects to Takeda at 1-844-217-6468 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

Before taking NINLARO, tell your healthcare provider about all your medical conditions, including if you:

have liver problems.

have kidney problems or are on dialysis.

are pregnant or plan to become pregnant. NINLARO can harm your unborn baby.
Females who are able to become pregnant:

Avoid becoming pregnant during treatment with NINLARO.
Your healthcare provider will do a pregnancy test before you start treatment with NINLARO.
You should use effective non-hormonal birth control during treatment and for 90 days after your last dose of NINLARO. If using hormonal contraceptives (for example, birth control pills), you should also use an additional barrier method of contraception (for example, diaphragm or condom). Talk to your healthcare provider about birth control methods that may be right for you during this time.
Tell your healthcare provider right away if you become pregnant or think you may be pregnant during treatment with NINLARO.
Males with female partners who are able to become pregnant:
You should use effective birth control during treatment and for 90 days after your last dose of NINLARO.
Tell your healthcare provider right away if your partner becomes pregnant or thinks she may be pregnant while you are being treated with NINLARO.

are breastfeeding or plan to breastfeed. It is not known if NINLARO passes into breast milk, if it affects an infant who is breastfed, or breast milk production. Do not breastfeed during treatment with NINLARO and for 90 days after your last dose of NINLARO.

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Talk to your healthcare provider before starting any new medicines during treatment with NINLARO.

Taking too much NINLARO (overdose) can cause serious side effects, including death. If you take more NINLARO than instructed by your healthcare provider, call your healthcare provider right away or go to the nearest hospital emergency room right away. Take your medicine pack with you.