While the European Society for Medical Oncology (ESMO) provides guidelines for patient treatment after initial relapse, these are not always perfect. Speaking from the 1st European Myeloma Network (EMN) Meeting 2018, held in Turin, Italy, Francesca Gay, MD, of the University of Turin, Turin, Italy, outlines an example of how these recommendations do not apply to patients who have relapsed whilst under lenalidomide treatment. Instead, Dr Gay presents some alternative options for therapy in these patients and mentions why there is a need for new strategies in the treatment of patients who have relapsed under lenalidomide in particular.