About one-third of all patients treated initially with chemotherapy will not obtain an objective response. And almost all patients with multiple myeloma who do respond to chemotherapy will eventually relapse if they do not die of some other disease in the meantime.
    The decision about further treatment after a relapse has to take a number of factors into account, including prior treatment, where the recurrence occurs and personal considerations.
• If the relapse occurs after the initial therapy has been stopped, therapy with the same melphalan-prednisone
  or multiple alkylating agent treatments is beneficial in a majority of patients.
• If the relapse occurs while melphalan and prednisone therapy is being used, a combination called VBAP
  (vincristine + BCNU + Adriamycin + prednisone) will be of some benefit to 40 percent of patients.
• If a patient has already received these agents or does not respond to VBAP, a combination of vincristine +
  Adriamycin + dexamethasone (VAD) can be given.
• If a patient is resistant to all of these agents or if the blood counts are low, a trial of high-dose prednisone or
  methyl-prednisone may be beneficial.