RVd (VRd)

Say it: AR-vee-dee

Lenalidomide, bortezomib and dexamethasone

RVd is a three medicine treatment, two pills and one shot, that is one of the most common first treatments for multiple myeloma.

Also called: VRd, RVD, Revlimid Velcade dexamethasone, RVd-lite, D-RVd, Dara-VRd, VRD

What it is

Each medicine attacks myeloma cells in a different way: lenalidomide helps the immune system and blocks myeloma growth, bortezomib blocks the cell's protein recycling system, and dexamethasone is a steroid that kills myeloma cells. Together they bring myeloma under control in most people. The goal is a deep, long lasting remission, often followed by a stem cell transplant and then maintenance pills.

Often used for

• newly diagnosed multiple myeloma
• treatment before a stem cell transplant
• first treatment for people who will not have a transplant

Dara-RVd (D-VRd)

Daratumumab, an antibody given as a shot or through a vein, is added to RVd. It deepens remission and is now often used for people who are fit for transplant, and increasingly for others.

RVd-lite

A gentler schedule with weekly bortezomib and fewer steroid days, often over 35 day cycles, for older or frail people.

Before and after transplant

Usually 3 to 6 cycles before a stem cell transplant, and sometimes 2 more cycles after (consolidation), then lenalidomide maintenance.

The medicines in this plan

Lenalidomide

Immune modulating pill taken once a day, usually on days 1 to 14 of each 21 day cycle. Only available through a special safety program.

Bortezomib

Proteasome inhibitor given as a shot under the skin of the belly, often on days 1, 4, 8 and 11, or once a week.

Dexamethasone

Steroid pill, usually taken on the days of the bortezomib shot and sometimes the day after, or once a week.

How you get it

RVd is mostly given as an outpatient. You take lenalidomide and dexamethasone pills at home and come to clinic for the bortezomib shot, which takes only a few minutes. Cycles are usually 21 days long, and most people get about 4 to 8 cycles, depending on whether a transplant is planned. Your schedule may be different.

A typical cycle

Day 1

Blood tests, bortezomib shot in clinic, dexamethasone pills. Start lenalidomide pills.

Days 1 to 14

Take lenalidomide once a day at about the same time.

Days 4, 8 and 11

Bortezomib shots in clinic, with dexamethasone pills on these days (and often the next day).

Days 15 to 21

No lenalidomide. A week off to let blood counts and nerves recover.

Common side effects and what helps

• Tingling, numbness or burning in hands and feet from bortezomib. Tell your team early, since changing the schedule can help.
• Tiredness. Short walks and regular sleep help.
• Low blood counts, which raise infection and bleeding risk. Wash hands often.
• Diarrhea or constipation. Drink fluids and tell your team, since both can be treated.
• Rash or itching from lenalidomide. Report any rash, especially with blisters or peeling.
• Trouble sleeping, mood changes, high blood sugar and big appetite on steroid days. Take dexamethasone in the morning.
• Swelling in the legs or muscle cramps. Raise your feet and stay active.
• Shingles (a painful blistered rash) can come back on bortezomib, so a preventive antiviral pill is given.

Call your care team right away if you have

• A fever of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher, or chills
• Swelling, pain, warmth or redness in one leg, or sudden shortness of breath or chest pain (signs of a blood clot)
• A rash with blisters, peeling skin or mouth sores
• Numbness or pain that makes it hard to walk, button clothes or hold things
• Dizziness or fainting when you stand up
• Diarrhea more than 4 times a day, or you cannot keep fluids down
• Unusual bleeding or bruising

Good to know

• Lenalidomide can cause severe birth defects. It is only given through a safety program (REMS) with pregnancy tests and birth control rules for anyone who could become pregnant, and condom use for men.
• Lenalidomide raises the risk of blood clots, so most people take aspirin or a blood thinner.
• You will take an antiviral pill (such as acyclovir) to prevent shingles while on bortezomib.
• Blood counts and kidney function are checked often, and lenalidomide is adjusted for kidney function.
• Myeloma blood and urine tests are checked each cycle or two to see how well treatment is working.
• If a transplant is planned, stem cells are often collected after about 4 cycles, since long lenalidomide use can make collection harder.

At home

• Swallow lenalidomide capsules whole with water; do not open, break or chew them.
• Use a pill calendar or phone alarm for the days you take each pill.
• Take your aspirin or blood thinner and your antiviral pill every day as prescribed.
• Take dexamethasone with breakfast to protect your stomach and help you sleep.
• Return unused lenalidomide to the pharmacy or clinic; never share it.

Questions to ask

• Am I a candidate for a stem cell transplant?
• Should daratumumab be added to my treatment?
• How many cycles will I get, and what comes after?
• Which medicine do I take to prevent blood clots, and for how long?
• What should I do if I miss a lenalidomide pill?

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.