Vd

Say it: vee-DEE

Bortezomib and dexamethasone

Vd is a simple two medicine treatment for multiple myeloma: a bortezomib shot plus dexamethasone pills.

Also called: VD, Velcade dexamethasone, bortezomib dexamethasone, Bd, DVd, SVd

What it is

Bortezomib blocks the protein recycling system that myeloma cells depend on, and dexamethasone is a steroid that kills myeloma cells. Vd works well even when the kidneys are not working well. It is often the backbone that newer medicines are added to. The goal is to control the myeloma for as long as possible.

Often used for

• multiple myeloma that came back
• myeloma in people with kidney failure
• first treatment for some older or frail people
• AL amyloidosis (often with cyclophosphamide)

Daratumumab added (DVd)

Daratumumab, an antibody, is added for myeloma that has come back. It helps control myeloma longer than Vd alone.

Selinexor added (SVd)

Selinexor pills are added once a week for myeloma that has come back, with weekly bortezomib.

Weekly bortezomib

Giving the shot once a week instead of twice a week causes less nerve damage and is common for older people.

Cyclophosphamide added (CyBorD or VCd)

Cyclophosphamide is added for some people, including those with AL amyloidosis or kidney failure.

The medicines in this plan

Bortezomib

Proteasome inhibitor given as a shot under the skin of the belly, often on days 1, 4, 8 and 11 of a 21 day cycle, or once a week.

Dexamethasone

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

How you get it

Vd is given as an outpatient. You come to clinic for the bortezomib shot, which takes only a few minutes, and take dexamethasone pills at home. Cycles are usually 21 days (twice weekly shots) or 28 to 35 days (weekly shots). How long you stay on it depends on how you respond and how well you tolerate it. Your schedule may be different.

A typical cycle

Day 1

Blood tests, bortezomib shot in clinic, dexamethasone pills.

Days 4, 8 and 11

Bortezomib shots, with dexamethasone pills on these days and often the day after.

Days 12 to 21

Rest days for nerves and blood counts to recover. Next cycle begins on day 22.

Common side effects and what helps

• Tingling, numbness or burning in hands and feet. Tell your team early, since adjusting the schedule can help.
• Tiredness. Short walks and regular sleep help.
• Low platelets, which can cause easy bruising. Your team checks counts before each shot.
• Diarrhea or constipation. Drink fluids and tell your team.
• Dizziness when standing from low blood pressure. Stand up slowly and drink fluids.
• Trouble sleeping, mood changes and high blood sugar on steroid days. Take dexamethasone in the morning.
• Redness or a small lump where the shot was given. This usually fades in a few days.
• Shingles (a painful blistered rash) can come back, 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
• Numbness or pain that makes it hard to walk, button clothes or hold things
• Fainting, or dizziness that does not go away when you sit down
• Unusual bleeding, black stools or many new bruises
• Shortness of breath, chest pain or new swelling of the legs
• Diarrhea more than 4 times a day, or you cannot keep fluids down
• A painful rash with blisters

Good to know

• You will take an antiviral pill (such as acyclovir) to prevent shingles while on bortezomib.
• Blood counts, especially platelets, are checked before shots.
• Nerve symptoms are checked at each visit, since the dose or schedule may be changed to protect your nerves.
• Myeloma blood and urine tests are checked regularly to see how well treatment is working.
• People with diabetes need closer blood sugar checks on dexamethasone days.

At home

• Take dexamethasone with breakfast to protect your stomach and help sleep.
• Take your antiviral pill every day as prescribed.
• Use a calendar to track shot days and pill days.
• Get up slowly from bed or a chair and drink plenty of fluids.
• Wear well fitting shoes and check your feet if they feel numb.

Questions to ask

• Should another medicine, such as daratumumab, be added to Vd for me?
• Will I get shots twice a week or once a week?
• How long will I stay on this treatment?
• What should I do if my hands or feet start tingling?
• How will we know if it is working?

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.