What does VTd stand for?

V = Velcade (bortezomib); T = thalidomide; d = dexamethasone (small d means a lower amount).

What are the common side effects of VTd?

Tingling, numbness or burning in hands and feet. Sleepiness and tiredness from thalidomide. Constipation, which is common with thalidomide. Dizziness when standing. Low blood counts, especially platelets. Trouble sleeping, mood changes and high blood sugar on steroid days. Swelling in the legs or rash. Shingles (a painful blistered rash) can come back, so a preventive antiviral pill is given.

When should I call my care team during VTd?

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); Numbness or pain that makes it hard to walk or hold things; A slow heartbeat, fainting or feeling very lightheaded; A rash with blisters, peeling skin or mouth sores; No bowel movement for 3 days or bad belly pain; Unusual bleeding or bruising.

VTd

Say it: vee-tee-DEE

Bortezomib, thalidomide and dexamethasone

VTd is a three medicine treatment for newly diagnosed multiple myeloma, used mainly before and after a stem cell transplant.

Also called: VTD, Velcade thalidomide dexamethasone, D-VTd, Dara-VTd, bortezomib thalidomide dexamethasone

What it is

Bortezomib, thalidomide and dexamethasone attack myeloma cells in different ways, so together they bring the disease under control quickly. VTd is used more often in Europe and other countries, while RVd (with lenalidomide) is more common in the United States. The goal is a deep remission before transplant.

V	Velcade (bortezomib)
T	thalidomide
d	dexamethasone (small d means a lower amount)

Often used for

newly diagnosed multiple myeloma before a stem cell transplant
consolidation after a stem cell transplant

Dara-VTd (D-VTd): Daratumumab, an antibody, is added to VTd before and after transplant. It leads to deeper remissions than VTd alone.
Consolidation after transplant: About 2 cycles of VTd (or Dara-VTd) are often given after the transplant, before maintenance.

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 each cycle.
Thalidomide: Immune modulating pill taken once a day, usually at bedtime because it causes sleepiness. Only available through a special safety program.
Dexamethasone: Steroid pill taken on set days of each cycle, often around the bortezomib shots.

How you get it

VTd is given as an outpatient. You take thalidomide and dexamethasone pills at home and come to clinic for bortezomib shots. Cycles are usually 21 or 28 days long, and most people get 4 to 6 cycles before transplant. Your schedule may be different.

A typical cycle

Day 1: Blood tests, bortezomib shot, dexamethasone. Start thalidomide at bedtime.
Every day: Thalidomide once a day at bedtime.
Days 4, 8 and 11: Bortezomib shots in clinic, with dexamethasone on set days.
End of cycle: Rest from shots, blood tests, then the next cycle. Stem cells are collected after the last induction cycle.

Common side effects and what helps

Tingling, numbness or burning in hands and feet. Both bortezomib and thalidomide can cause this, so tell your team early.
Sleepiness and tiredness from thalidomide. Take it at bedtime and do not drive if you feel drowsy.
Constipation, which is common with thalidomide. Drink fluids and use a stool softener if your team advises.
Dizziness when standing. Get up slowly.
Low blood counts, especially platelets. Your team checks counts each cycle.
Trouble sleeping, mood changes and high blood sugar on steroid days. Take dexamethasone in the morning.
Swelling in the legs or rash. Report any rash.
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
Swelling, pain, warmth or redness in one leg, or sudden shortness of breath or chest pain (signs of a blood clot)
Numbness or pain that makes it hard to walk or hold things
A slow heartbeat, fainting or feeling very lightheaded
A rash with blisters, peeling skin or mouth sores
No bowel movement for 3 days or bad belly pain
Unusual bleeding or bruising

Good to know

Thalidomide causes severe birth defects. It is only given through a safety program (REMS) with pregnancy tests and birth control rules, and condom use for men.
Thalidomide 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.
Nerve symptoms are checked at each visit, since nerve damage from two medicines can add up.
Stem cell collection and transplant planning happen during or after the last cycles.

At home

Take thalidomide at bedtime with water; do not open or break the capsules.
Take your aspirin or blood thinner and antiviral pill every day as prescribed.
Eat fiber, drink fluids and keep moving to prevent constipation.
Use a pill calendar or phone alarms for pill days.
Return unused thalidomide to the pharmacy or clinic; never share it.

Questions to ask

Why VTd for me instead of RVd?
Should daratumumab be added?
How many cycles before my transplant?
Which medicine do I take to prevent blood clots?
What should I do if my nerves start tingling?

Multiple myeloma

Sources

Quick answers

What is VTd?: VTd is a three medicine treatment for newly diagnosed multiple myeloma, used mainly before and after a stem cell transplant. Bortezomib, thalidomide and dexamethasone.
What does VTd stand for?: V = Velcade (bortezomib); T = thalidomide; d = dexamethasone (small d means a lower amount).
How is VTd given?: VTd is given as an outpatient. You take thalidomide and dexamethasone pills at home and come to clinic for bortezomib shots. Cycles are usually 21 or 28 days long, and most people get 4 to 6 cycles before transplant. Your schedule may be different.
What are the common side effects of VTd?: Tingling, numbness or burning in hands and feet. Sleepiness and tiredness from thalidomide. Constipation, which is common with thalidomide. Dizziness when standing. Low blood counts, especially platelets. Trouble sleeping, mood changes and high blood sugar on steroid days. Swelling in the legs or rash. Shingles (a painful blistered rash) can come back, so a preventive antiviral pill is given.
When should I call my care team during VTd?: 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); Numbness or pain that makes it hard to walk or hold things; A slow heartbeat, fainting or feeling very lightheaded; A rash with blisters, peeling skin or mouth sores; No bowel movement for 3 days or bad belly pain; Unusual bleeding or bruising.

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.