In patients with biochemical relapse with a small increase in M protein levels in the serum or urine, treatment is not initiated immediately. In patients with a steep increase in M protein levels, a doubling or presentation of symptoms, treatment should be initiated. Re-treatment with bortezomib and lenalidomide is a possible option in the relapsed patient, particularly if the relapse is more than 2 years since treatment was given.
In a clinically relapsed patient or in those who relapse occurs within 2 years, a new treatment regimen from that first used should be considered.
For patients refractory to bortezomib or lenalidomide, new proteasome inhibitors and immunomodulatory drugs are available, including carfilzomib and pomalidomide. These may provide alternative treatment options and change the outcome of relapsed MM patients in the future.

This programme has been supported by an unrestricted educational grant from Janssen Pharmaceutica (A Johnson & Johnson Company).