There are many therapeutic regimens available to treat relapsed or progressive MM. The choice

of salvage regimen should take into account 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.

In managing people with relapsed or progressive MM, enrolment into a clinical trial is the first preference. If no clinical trial is available, treatment may include these options (Quach & Prince 2019):

• using a different drug regimen that contains drugs of a different class or a different drug of the same class
• retreatment with a previous regimen for those who achieved treatment-free remission of at least one year without significant toxicity, but response length and quality will likely not be as good as before
• salvage ASCT in fit patients who achieved a durable response after the first ASCT and who have enough stem cells in storage
• conventional doses of cyclophosphamide, non-myeloablative doses of melphalan, low-modest doses of corticosteroids or palliation (after all newer agents and different treatment combinations have been exhausted).

Refer to the updated MSAG clinical guideline for managing relapsed MM (Quach & Prince 2019).

The potential goals of treatment should be discussed, respecting the patient’s cultural values. Wherever possible, written information should be provided.