Latest Cancer TreatmentsDr. Mohammadreza Dabiri
Dr. Mohammadreza Dabiriفارسی
Treatment regimen

VRd and D-VRd regimens in myeloma

Bortezomib, lenalidomide and dexamethasone, with or without daratumumab

Updated: 28 October 20261 min read4 references

Summary for doctors

  • Induction for newly diagnosed myeloma, before autologous transplant or in non-transplant patients [1, 2].
  • Adding daratumumab (D-VRd) before and after transplant greatly lengthened progression-free survival [2].
  • Thrombosis prophylaxis and aciclovir are mandatory.

Dose and schedule

VRd

Newly diagnosed myeloma, inductionCycle length: Every 21 days

Newly diagnosed myeloma, induction

DrugDoseRouteSchedule
Bortezomib1.3 mg/m²IV (subcutaneous today)Days 1, 4, 8 and 11
Lenalidomide25 mgOralDays 1 to 14
Dexamethasone20 mgOralDays 1, 2, 4, 5, 8, 9, 11 and 12
Cycle length
Every 21 days
Duration
8 cycles, then maintenance lenalidomide and dexamethasone

As in SWOG S0777 [1].

Dose source: [3].

D-VRd

Newly diagnosed transplant-eligible myeloma: induction and consolidationEach drug’s schedule in the table

Newly diagnosed transplant-eligible myeloma: induction and consolidation

DrugDoseRouteSchedule
Induction: 4 cycles
Daratumumab1800 mgSubcutaneousWeekly in cycles 1 and 2; every 2 weeks in cycles 3 and 4
Bortezomib1.3 mg/m²SubcutaneousDays 1, 4, 8 and 11
Lenalidomide25 mgOralDays 1 to 21
Dexamethasone40 mgOral or IVDays 1 to 4 and 9 to 12
Cycle schedule
Every 28 days
Duration
4 induction cycles, autologous transplant, 2 consolidation cycles, then maintenance daratumumab and lenalidomide

As in PERSEUS [2].

Dose source: [4].

Evidence: PERSEUS (2024)

Doses follow the trial protocol, guideline or official drug label (source given in the notes of each regimen). Before prescribing, check blood counts, renal and hepatic function, drug interactions and the patient’s condition, and adjust the dose according to the drug label.

Premedication and supportive care

  • Thrombosis: aspirin at low risk; low-molecular-weight heparin or an oral anticoagulant at high risk.
  • Aciclovir or valaciclovir for shingles; consider pneumocystis prophylaxis with high-dose dexamethasone.
  • Daratumumab: premedication (paracetamol, antihistamine, dexamethasone); before starting, blood group and antibody screen (daratumumab makes the indirect Coombs test positive).
  • Stem cell collection after 3 to 4 cycles of lenalidomide (to limit its effect on collection).

Monitoring and dose adjustment

  • Adjust lenalidomide for kidney function (creatinine clearance 30 to 60: 10 mg daily).
  • Bortezomib neuropathy: give it subcutaneously and weekly; grade 2 with pain or grade 3: reduce or hold.
  • Blood counts before each cycle and weekly in cycle 1.

Main evidence

Show detailsHide

S0777: adding bortezomib to Rd increased median progression-free survival from 30 to 43 months and median overall survival from 64 to 75 months [1]. PERSEUS: 4-year progression-free survival 84.3% with D-VRd vs 67.7% with VRd [2].

Related cancer types

Multiple myeloma

Treatment regimens (physicians)

DRd regimen (daratumumab, lenalidomide, dexamethasone) in myelomaKRd regimen (carfilzomib, lenalidomide, dexamethasone) in myeloma

Physician tools and lessons

HCT-CI Comorbidity Index Before Stem Cell TransplantationMyeloma Staging Calculator: ISS, R-ISS and R2-ISSIndications for haematopoietic stem cell transplantation, donor selection and conditioningGraft-versus-host disease (GVHD): prophylaxis, grading and treatmentBone-modifying agents in cancer: bone metastases, adjuvant use and osteonecrosis of the jaw

References

4 references
Show all references, 1 with a study cardClose the reference list

Numbers in the text, such as [1], refer to these sources. Sources with a “Study card” button are summarised in the site’s evidence library.

  1. 1
    Bortezomib with lenalidomide and dexamethasone versus lenalidomide and dexamethasone alone in patients with newly diagnosed myeloma without intent for immediate autologous stem-cell transplant (SWOG S0777): a randomised, open-label, phase 3 trialDurie BGM, Hoering A, Abidi MH, et al · Lancet · 2017;389:519-527
    DOIPubMed Back to text: 1 2 3
  2. 2
    Daratumumab, Bortezomib, Lenalidomide, and Dexamethasone for Multiple MyelomaSonneveld P, Dimopoulos MA, Boccadoro M, et al · N Engl J Med · 2024;390:301-313
    Study cardDOIPubMed Back to text: 1 2 3 4
  3. 3
    BORTEZOMIB — Prescribing InformationShilpa Medicare Limited · FDA label · 2026
    Source Back to text
  4. 4
    DARZALEX FASPRO (DARATUMUMAB AND HYALURONIDASE-FIHJ (HUMAN RECOMBINANT)) — Prescribing InformationJanssen Biotech, Inc · FDA label · 2026
    Source Back to text

This page is based on reputable scientific sources and was last updated on 28 October 2026. The content of this website is for educational and informational purposes only and does not replace consultation, diagnosis or treatment by a specialist physician. Consult your treating physician about any treatment decision.

Printed from the website; the full and up-to-date version: https://drdabiri.com/en/regimens/vrd-myeloma/

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