STEP 6: Managing relapsed or refractory disease


Most relapsed or progressive disease will be detected via routine follow-up blood tests or by the presence of symptoms.


Treatment will depend on patient factors (age and frailty), disease factors (tempo of relapse, risk-group stratification), prior treatment-related factors (responsiveness and side effects to prior treatment type) and the patient’s preferences.

When managing people with relapsed or refractory MM, consider a clinical trial. If no clinical trial is available, a different treatment regimen than was previously used can be given.

Advance care planning

Advance care planning is important for all patients but especially those with advanced disease. It allows them to plan for their future health and personal care by thinking about their values and preferences. This can guide future treatment if the patient is unable to speak for themselves.

Survivorship and palliative care

Survivorship and palliative care should be addressed and offered early. Early referral to palliative care can improve quality of life. Referral should be based on need, not prognosis.


The lead clinician and team’s responsibilities include:

  • explaining the treatment intent, likely outcomes and side effects to the patient, family and/or carer and the patient’s GP.


  • Treatment intent, likely outcomes and side effects explained to the patient, family and/or carer and the patient’s GP
  • Supportive care needs assessed and referrals to allied health and community support services as required
  • Advance care planning discussed with the patient, family and/or carer
  • Patient referred to palliative care if appropriate
  • Routine follow-up visits scheduled