DRd

Say it: D R D

Daratumumab, lenalidomide and dexamethasone

DRd is a three medicine plan for multiple myeloma, combining an antibody (daratumumab), daily pills (lenalidomide) and a steroid (dexamethasone).

Also called: DRD, Dara-Rd, Dara-Len-Dex, daratumumab lenalidomide dexamethasone, Darzalex Revlimid dexamethasone, D-Rd

What it is

Daratumumab marks myeloma cells so the immune system can destroy them. Lenalidomide helps the immune system and slows myeloma growth. Dexamethasone kills myeloma cells directly. It is often given for a long time to keep the myeloma under control.

Often used for

• newly diagnosed multiple myeloma in people who are not getting a stem cell transplant
• multiple myeloma that has come back

Shot vs IV daratumumab

Most people now get daratumumab as a shot under the skin, which takes only a few minutes. The IV form takes several hours, longest the first time.

First treatment vs relapse

The same plan is used as a first treatment for people not getting a transplant, and for myeloma that has come back.

The medicines in this plan

Daratumumab

Antibody that targets a protein (CD38) on myeloma cells. Given as a shot under the skin over a few minutes, or through a vein over several hours.

Lenalidomide

Capsules taken by mouth once a day on days 1 to 21 of each 28 day cycle.

Dexamethasone

Steroid taken by mouth or through a vein, usually once a week. The dose is often lowered or stopped over time.

How you get it

Daratumumab is given in the clinic, weekly for the first 2 cycles, every 2 weeks for cycles 3 to 6, then every 4 weeks. Lenalidomide is taken at home. Each cycle is 28 days, and treatment usually continues as long as it works and is tolerated. Your schedule may be different.

A typical cycle

Cycles 1 and 2

Daratumumab once a week (days 1, 8, 15 and 22).

Cycles 3 to 6

Daratumumab every 2 weeks (days 1 and 15).

Cycle 7 onward

Daratumumab once every 4 weeks (day 1).

Days 1 to 21 of every cycle

Lenalidomide capsule once a day at home, then 7 days off. Dexamethasone once a week.

Common side effects and what helps

• Low white blood cell counts, which raise the risk of infection. Wash your hands often and stay away from people who are sick.
• Lung and sinus infections, like colds or pneumonia. Tell your team about cough or fever.
• Reactions during or after the first daratumumab dose, such as stuffy nose, cough, chills or throat tightness. Medicines are given beforehand to help.
• Diarrhea, which is common with long term lenalidomide. Tell your team, since there are medicines that help.
• Tiredness. Rest and short walks can help.
• Swelling in the legs or feet. Raise your legs when you sit.
• Muscle cramps and back pain. Tell your team if they bother you.
• Trouble sleeping, mood changes and high blood sugar on dexamethasone days. Take it in the morning with food.

Call your care team right away if you have

• A fever of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher, or chills
• Trouble breathing, wheezing or throat tightness during or after a daratumumab dose
• Swelling, pain or warmth in one leg or arm, or sudden shortness of breath (signs of a blood clot)
• Trouble breathing, chest pain, or a fast or pounding heartbeat
• Bleeding that will not stop, blood in your urine or stool, or many new bruises
• A new rash with blisters or peeling skin

Good to know

• Lenalidomide can cause severe birth defects. You must follow a safety program: pregnancy tests and birth control for those who could become pregnant, and condoms for men. Do not donate blood or sperm.
• Lenalidomide raises the risk of blood clots. Most people take aspirin or another blood thinner.
• Daratumumab can interfere with blood bank tests. You will have a blood type test before the first dose, and you should tell any hospital that you take it.
• Your team will check for hepatitis B before starting, because daratumumab can wake up an old infection.
• Lenalidomide is cleared by the kidneys. Your dose depends on your kidney blood tests.

At home

• Take lenalidomide at the same time each day. Swallow it whole and do not open the capsules.
• Take your blood thinner and any antiviral medicine as prescribed.
• Carry a card or note that says you take daratumumab.
• Drink plenty of fluids, especially if you have diarrhea.
• Wash your hands often and stay away from people who are sick.

Questions to ask

• Will I get daratumumab as a shot or through a vein?
• How long will I stay on this treatment?
• Can my dexamethasone dose be lowered over time?
• Which blood thinner should I take?
• How will we track whether the myeloma is responding?

Multiple myeloma

Last updated: 2026-10-27. Medically reviewed by Veli Bakalov, MD, medical oncologist (October 2026). General education from Step by Step, the patient portal of HemeOncBuddy.