PBD

Say it: P-B-D

Panobinostat, bortezomib and dexamethasone

PBD adds the pill panobinostat to bortezomib and dexamethasone for multiple myeloma that has come back, but it is now rarely used in the United States.

Also called: PVd, Pano-Vd, Panobinostat-Vd, FVD, Panobinostat, bortezomib, dexamethasone

What it is

Panobinostat changes how myeloma cells read their genes (an HDAC inhibitor), and bortezomib blocks the cells' waste disposal system. Together with the steroid dexamethasone, they attack myeloma in several ways. The goal is to control myeloma that has returned. Panobinostat was taken off the US market in late 2021, so you may only see this plan in other countries, in older treatment plans, or in special cases.

Often used for

• Multiple myeloma that came back after at least two earlier treatments, including bortezomib and an immune medicine like lenalidomide

The medicines in this plan

Panobinostat

An HDAC inhibitor capsule taken by mouth on days 1, 3, 5, 8, 10 and 12 of each 21 day cycle. No longer sold in the United States.

Bortezomib (Velcade)

A proteasome inhibitor given as a shot under the skin (or into a vein) on days 1, 4, 8 and 11 for the first cycles, then less often.

Dexamethasone

A steroid pill taken on the day of and the day after each bortezomib dose.

How you get it

Bortezomib shots are given in an outpatient clinic, and panobinostat and dexamethasone are pills taken at home. Each cycle is 21 days, with 2 weeks of treatment and 1 week off. In the original plan, people got up to 8 cycles, and some continued for up to 16 cycles with a lighter schedule. Your schedule may be different.

A typical cycle

Days 1, 4, 8 and 11

Clinic visit for a bortezomib shot. Dexamethasone that day and the next.

Days 1, 3, 5, 8, 10 and 12

Panobinostat capsule at home, at about the same time each day.

Days 13 to 21

Rest week. Blood tests before the next cycle.

Common side effects and what helps

• Diarrhea, which can be severe. Start your diarrhea medicine at the first loose stool and drink lots of fluids.
• Low platelets, with easy bruising or bleeding. Use a soft toothbrush and an electric razor.
• Tiredness and weakness. Rest when needed and keep up light activity.
• Nausea, vomiting and poor appetite. Take anti-nausea medicine as prescribed.
• Tingling or numbness in hands and feet from bortezomib. Tell your team early.
• Low white blood cells and higher infection risk. Wash hands often.
• Swelling of the legs, and lightheadedness when standing. Stand up slowly.
• Trouble sleeping and high blood sugar on dexamethasone days.

Call your care team right away if you have

• A fever of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher, or chills
• Diarrhea 4 or more times a day above normal, or diarrhea that does not improve with your medicine
• A fast, pounding or uneven heartbeat, fainting, or chest pain
• Bleeding that will not stop, black stools, or vomiting blood
• Feeling dizzy or faint, or passing very little urine
• A painful rash with blisters on one side of the body (shingles)
• Shortness of breath or a new cough

Good to know

• Panobinostat was withdrawn from the US market in 2021. It is now rarely used in the US, though it may still be available in some other countries.
• Panobinostat can cause severe diarrhea and serious heart rhythm problems. Heart tracings (ECGs) and blood salt levels (potassium and magnesium) are checked before and during treatment.
• Platelet counts are checked often, and you may need platelet transfusions or a pause in treatment.
• Bortezomib can wake up the shingles virus, so most people take an antiviral pill to prevent it.
• Many medicines change panobinostat levels or affect heart rhythm. Check with your team before taking anything new.

At home

• Keep diarrhea medicine at home and follow your team's plan exactly.
• Drink about 8 to 10 cups of fluid a day.
• Avoid grapefruit, star fruit and pomegranate, which can raise panobinostat levels.
• Use a calendar to track pill days and shot days.
• Check your temperature if you feel unwell.

Questions to ask

• Why is this plan right for me, given that panobinostat is no longer sold in the US?
• How will I get panobinostat?
• How often will I have heart tracings (ECGs)?
• What other treatment options do I have?
• What should I do if diarrhea starts at night?

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.