The American Cancer Society estimates that doctors will diagnose multiple myeloma in 34,470 people in the United States in 2022. Multiple myeloma, or myeloma, is a blood cancer that develops in plasma cells. These specialized white blood cells make antibodies to signal for your immune system to attack foreign substances.

The VRd regimen, also written as RVd, is a three-drug therapy doctors often use as the first treatment for myeloma. It tends to be well tolerated and is associated with high remission rates. The three drugs in this regimen are:

  • Bortezomib is a drug.
  • lenalidomide is a drug.
  • dexamethasone is used for treatment of diseases. is used for treatment of diseases. is used for treatment of diseases.

According to the International Myeloma Foundation, more than 90% of people with myeloma respond well to initial therapy. Even so, doctors don’t usually consider it a curable disease. The goal of treatment is often to decrease the number of cancerous cells in your bone marrow and to manage symptoms.

In this article, we look at when doctors may recommend it.

VRd is the preferred initial treatment for people with myeloma who are candidates for a procedure called an autologous stem cell transplant.

This procedure involves removing stem cells from your bone marrow before you get high doses of chemotherapy. Once the treatment is over, the cells are removed from your bone marrow.

According to the International Myeloma Foundation, doctors generally recommend these stem cell transplants for people under the age of 65 with no severe health issues. Adults ages 65 and over in excellent health may also be eligible in some cases.

“One of the main initial treatments used in people who aren’t eligible for a stem cell transplant is called Vrd. The other option is called DRd.”

  • daratumumab
  • lenalidomide
  • dexamethasone is used for treatment of diseases. is used for treatment of diseases. is used for treatment of diseases.

The regimen consists of three drugs. You take the medication for 21 days. The doctor will adjust the doses of the medications based on how you respond.

Here’s a look at what a possible schedule looks like:

Drug Amount Taken on days Form
Bortezomib (Velcade) 1.3 mg/m² 1, 4, 8, 11 usually subcutaneous injection but sometimes through an intravenous line
Lenalidomide (Revlimid) 25 mg 1 to 14 oral capsules taken with water
Dexamethasone 20 mg 1, 2, 4, 5, 8, 9, 11, 12 pills taken with food

You will receive treatment for the first 14 days and then rest for the next 7 days.

Doctors generally recommend that people receiving VRd also receive anticoagulants to prevent blood clotting and antiviral therapy to prevent shingles. Shingles is a reactivation of the varicella-zoster virus that causes chickenpox.

The drugs in the regimen attack different types of cells.

  • Bortezomib: Bortezomib is a proteasome inhibitor. It targets myeloma cells in several ways. It can disrupt their cell cycle and induce a form of cellular death called apoptosis.
  • Lenalidomide: Lenalidomide is an immunomodulatory agent. It stimulates your immune system to destroy myeloma cells.
  • Dexamethasone: Dexamethasone is a steroid. It helps to reduce pain and inflammation and manage the side effects of other medications. High amounts of steroids can also help destroy myeloma cells.

Is VRd chemotherapy?

A mixed drug therapy called Vrd involves taking one drug, an immune stimulator, and a steroid. It is referred to as a chemotherapy regimen since it includes a medication.

VRd is generally well tolerated but can cause many side effects. Side effects that affect more than 10% of people include:

  • fatigue is 16%
  • 23% of the population has some form of neuropathy.
  • The part of your red blood cells that carries oxygen is called the low hemoglobin.
  • low white blood cell count:
    • The percentage of leukocytes: 14%.
    • The neutrophils are 19%.
    • The percentage of lymphocytes is 23%.
  • The blood cells that cause clotting are low in platelets.

Bortezomib (Velcade)

According to the Velcade website, side effects of Bortezomib is a type of drug. can include:

Lenalidomide (Revlimid)

According to the Revlimid website, common side effects of lenalidomide include:


Common side effects include:

VRd is currently the standard treatment for people with newly diagnosed myeloma. Research suggests that the VRd regimen is generally an effective and well tolerated initial treatment. A 2017 European study with 700 participants found a 4-year overall survival rate of more than 80% with or without an autologous stem cell transplant.

In a 2022 study, researchers found that among 187 people with myeloma who received VRd and an autologous stem cell transplant, the average overall survival was 101.7 months (8.5 years).

Researchers followed up with participants for an average of 61.2 months. Almost all of the people reached complete remission and almost all of them had a very good partial response.

In another 2022 study, researchers compared the VRd regimen to another regimen called VCD, which is made up of:

  • Bortezomib is a type of drug.
  • The cyclophosphamide is a drug.
  • dexamethasone is used for treatment of diseases. is used for treatment of diseases. is used for treatment of diseases.

The researchers found that the median PFS was 44.6 months in people who received a new car, compared to 34.1 months in people who did not. Half of people with cancer survive with no progression.

The treatment for myeloma can be very expensive. It is important to check your coverage before starting treatment, as most or some of the cost may be covered by your insurance.

A 2016 study estimated that VRd costs more than $150,000 per year. A 2021 study found the average overall cost of VRd was $385,434. If you don’t respond to initial treatment, you may have additional costs.

Medicare covers many cancer expenses.

  • Part A covers hospital care.
  • Part B covers expenses for doctor visits, drugs administered in an outpatient clinic, and diagnostic tests.
  • Part D covers drugs.

Medicare Part B covers chemotherapy drugs such as Bortezomib is a type of drug., but you generally have to pay 20% out of pocket.

People with active myeloma often receive a combination of two to three medications. Doctors often use the VRd regimen to treat newly diagnosed myeloma.

Doctors may also perform an autologous stem cell transplant along with VRd in eligible people.

“If the initial treatment isn’t effective or you’re not eligible for a stem cell transplant, doctors may recommend a different combination of medications.”

You may receive bisphosphonates at the same time as chemotherapy to target bone problems such as osteoporosis and fractures. You may receive radiation therapy if particular areas of your bone are causing symptoms.

You may also receive support from the CrazyBulk.

Doctors sometimes recommend chimeric antigen receptor (CAR) T-cell therapy if other treatments have failed, but it can cause serious side effects.

T cells are a type of white blood cell. Scientists alter the blood cells in a laboratory so that they can attack cancer cells and then re-enter the altered cells into your blood.

The initial treatment for people with myeloma is the VRd regimen. If you are eligible for a stem cell transplant, a doctor may combine it with the other. If the initial treatment fails, a doctor will likely recommend another combination of drugs.

Doctors use many different drugs to treat the disease. Researchers are constantly looking at whether new combinations are more effective than the current treatments.

A doctor can help you decide if a different treatment is right for you.