The short answer
Relapsed means the myeloma came back after a response; refractory means it is not responding now. The practical question at this point is which drug classes you have already used, whether anything has been aimed at BCMA, and which trial you qualify for today but might not after the next line.
Relapsed and refractory are different words, and many people are both. Treatment is given as a sequence of new options as they are needed.
The fastest way to narrow the list is by class: antibodies, proteasome inhibitors, CAR T cells, bispecific antibodies, immunomodulatory pills, an antibody-drug conjugate, and others such as selinexor and venetoclax.
In the teclistamab study of 165 people with at least four prior treatments, 63.0 percent responded and median progression-free survival was 11.3 months.
Cytokine release syndrome occurred in 72 percent on teclistamab, grade 3 or 4 in only one patient, with grade 3 or 4 blood count toxicity in 61 percent including febrile neutropenia in 44.8 percent.
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The full explanation.
What refractory actually means
Relapsed means the myeloma came back after a response. Refractory means it is not responding to the treatment you are on now, or it progressed during it.
Many people are both at once. NCI's summary handles them together, and the general strategy it describes is simple to state: give new treatments one after another, as they are needed.
The classes, and which you have used
The list NCI gives for relapsed or refractory myeloma is long, and it is organised by class rather than by name.
- Antibodies. NCI names daratumumab, elotuzumab and isatuximab.
- Proteasome inhibitors. These are bortezomib, carfilzomib and ixazomib.
- CAR T cells. Two are named: cilta-cel and ide-cel.
- Bispecific antibodies. These are teclistamab, talquetamab and elranatamab.
- Pills that act on the immune system. These are pomalidomide, lenalidomide and thalidomide.
- One antibody linked to a drug. It is belantamab mafodotin.
- Others. These include selinexor, venetoclax, steroids and chemotherapy.
Bring your own list to the visit. Which classes have you had, and did each one work? That answer narrows this list faster than anything else.
CAR T cells and bispecific antibodies
These are the newer routes, and both target a protein called BCMA on myeloma cells.
NCI describes a study of teclistamab in 165 people who had already had at least four treatments. About 63 percent responded, and 39 percent had a complete response. The median time before the disease progressed was 11.3 months.
It also reports the side effects honestly. Cytokine release syndrome occurred in 72 percent, though severe cases were rare. Serious blood count problems occurred in 61 percent, including fever with low white cells in about 45 percent.
Ask what monitoring those first weeks require, and whether you would need to stay near the hospital.
What has already been aimed at BCMA
This matters more than it sounds. In the same study, 40 people had already received a BCMA-targeted treatment. Their response rate was 52.5 percent, lower than the group overall.
So ask whether you have had a BCMA drug before, and what that means for the next one.
Trials, and why timing matters
NCI recommends trials throughout this section. Eligibility often depends on how many treatments you have already had.
That means a trial you might qualify for today may be closed to you after the next line. Ask about trials before starting something new, not after.
Questions for a later-line decision
- Which drug classes have I already had?
- Which of them stopped working, and how quickly?
- Have I had anything aimed at BCMA?
- Am I a candidate for CAR T cells or a bispecific antibody?
- What would the first month of that look like day to day?
- Is there a trial I would qualify for now but not later?
- What is the goal of this next treatment?
When to get help sooner
- Call 911 or go to an emergency department if you have trouble breathing, faint or nearly faint, or have a seizure in the weeks after a bispecific antibody or CAR T-cell infusion. Cytokine release syndrome can drop blood pressure and oxygen levels quickly.
- Call 911 or go to an emergency department if you develop new weakness in your legs, numbness in the legs or groin, trouble walking, or loss of bladder or bowel control. Pressure on the spinal cord from a spine lesion is an emergency.
- Call your myeloma team at once, day or night, if you have a temperature of 100.4°F (38°C) or higher, or chills, at any point in later-line treatment. Do not leave a routine message and wait. On teclistamab, fever is the usual first sign of cytokine release syndrome, and fever with low white cells was reported in about 45 percent of people in the study above. The CDC classes fever during chemotherapy as a medical emergency. If you cannot get through fast, go to an emergency department and tell them which treatment you are on.
- Call your care team the same day if you feel confused or muddled, your speech or handwriting changes, or you are unusually sleepy or dizzy. Nerve and brain effects are known with these drugs, and they are graded and treated.
- Call your care team within a day or two if you have a bad headache, a fast heartbeat, a new rash, or new numbness, tingling, or weakness in the hands or feet.
Related pages
Cancer Staging and Biomarker Testing explain the terms used in relapsed or refractory multiple myeloma. Clinical Trial vs Standard Treatment, Palliative Care, and Questions to Ask Your Doctor cover what to weigh when multiple myeloma stops responding.
Where this comes from
These questions were drawn from current patient guidance for multiple myeloma:
Words to know
Tap any term to see what it means.
Common questions
What is the difference between relapsed and refractory?
Relapsed means the myeloma came back after a response. Refractory means it is not responding to the treatment you are on now, or progressed during it. Many people are both at once, and NCI's summary handles them together.
Why does my team keep asking which drugs I have had?
Because the options are organised by class, and what you have already used and what stopped working narrows the list faster than anything else. Bring your own list of classes and how each one performed.
How well does a bispecific antibody work this late?
In the study NCI cites, teclistamab was given to 165 people who had at least four prior treatments. The overall response rate was 63.0 percent, with a complete response in 39.4 percent, and median progression-free survival of 11.3 months.
Does having had a BCMA drug already change things?
It appears to. Of the 165 patients, the 40 who had already received a BCMA-targeted antibody-drug conjugate or CAR T-cell therapy had a response rate of 52.5 percent, lower than the group as a whole. Ask whether anything you have had was aimed at BCMA.
What should I expect in the first weeks of a bispecific antibody?
Close monitoring. Cytokine release syndrome occurred in 72 percent in the teclistamab study, and fever is usually its first sign. Ask what monitoring is required and whether you need to stay near the hospital.
Questions to ask your doctor
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Sources last checked: 2026-08-13 what this meansLast updated: 2026-08-18Next planned review: 2027-07-30
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How this page was created
Cancer Explained does not originate medical claims. Every page restates guidance already published by the National Cancer Institute, the CDC, the USPSTF and the FDA, in plain language, with the source cited so you can check the original yourself. AI does the translating and organizing; automated checks test claims, citations, clarity and safety before anything publishes. We do not employ clinicians and do not intend to — our work is translation and navigation, not clinical judgment. Nothing here is personal medical advice, and no page can account for your particular situation.
Editorial status: Source checked — This page was written with AI assistance and checked line by line against the sources listed on it. That confirms the sources support what the page says. It is not a medical review, and it does not confirm the page is complete or right for your situation.
Human medical review: not completed. Pages here are not signed off by a clinician before they publish. That is not an oversight we are quietly working around: we restate published guidance and cite it, so the authority belongs to the source rather than to us, and every page names where its claims come from — you can verify us instead of trusting us. Where a volunteer clinician has reviewed a page, their name and credentials appear on it; where no name appears, no clinician has checked it. We are glad to have reviewers and are recruiting them, and we do not hold pages back waiting for one. Use this site to understand your situation and to ask better questions of the people treating you.
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Related articles
- What Is Multiple Myeloma?
- Cancer Staging: What the Stage Means
- Biomarker Testing and Precision Medicine
- Getting a Second Opinion After a Diagnosis
- Questions to Ask About Multiple myeloma Treatment
- Multiple myeloma Recurrence: What to Ask
- Multiple myeloma Survivorship Follow-Up Questions
- Metastatic Cancer: When Cancer Spreads
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