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An indolent serologic relapse may be treated with dose intensification, especially in a maintenance situation, whereas a rapid relapse requires a more aggressive approach with drug class change or a second-generation immunomodulatory drug (IMID) or proteasome inhibitor (PI). Monoclonal antibodies, in combination with PIs and IMIDs, have proven highly efficacious in early and late relapse. Key elements of supportive care include infection prevention, bone health, thromboprophylaxis, and management of active symptoms, such as pain and distress.<\/jats:p>","DOI":"10.1182\/hematology.2019000016","type":"journal-article","created":{"date-parts":[[2019,12,6]],"date-time":"2019-12-06T15:10:17Z","timestamp":1575645017000},"page":"125-136","update-policy":"http:\/\/dx.doi.org\/10.1182\/blood.2019cm0000","source":"Crossref","is-referenced-by-count":2,"title":["How I treat a refractory myeloma patient who is not eligible for a clinical trial"],"prefix":"10.1182","volume":"2019","author":[{"given":"Siyang","family":"Leng","sequence":"first","affiliation":[{"name":"Columbia University Vagelos College of Physicians and Surgeons, New York, NY"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Divaya","family":"Bhutani","sequence":"additional","affiliation":[{"name":"Columbia University Vagelos College of Physicians and Surgeons, New York, 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