Bortezomib — the 'V' in both VRd and VCd — is a proteasome inhibitor, not a traditional chemotherapy agent. It works by blocking the protein-disposal system inside cells that myeloma depends on to survive.
VRd and VCd: — What Your Myeloma Regimen Actually Contains
VRd and VCd are combination regimens for multiple myeloma. Most people see these letters on a hospital chart without being told what each one stands for. This page names every drug and explains why myeloma treatment is structured differently from other cancers.
- VRd = bortezomib + lenalidomide + dexamethasone — Three medicines used together as a standard combination for newly diagnosed multiple myeloma.
- VCd = bortezomib + cyclophosphamide + dexamethasone — The same backbone with cyclophosphamide in place of lenalidomide.
- Treatment runs in phases, often for years — Myeloma is managed long-term — induction, then often maintenance — not as a fixed short course.
- Your oncologist decides the plan — Which regimen, how many cycles and what comes next depends on your individual disease and fitness.
Medically reviewed by Dr. C. Raghavendra Reddy, Medical Oncologist, MBBS (Gold Medal) · DNB · DM (Medical Oncology, Gold Medal) · Last reviewed September 2026
VRd stands for bortezomib, lenalidomide and dexamethasone. VCd substitutes cyclophosphamide for lenalidomide. Both are combination regimens for multiple myeloma, given in repeating cycles. Myeloma treatment is structured in phases — induction, then often maintenance — and is planned in years rather than a set number of cycles. Your oncologist will explain what the plan looks like for you.
What do VRd and VCd stand for?
VRd stands for three medicines used together: Bortezomib (V), Lenalidomide (R) and Dexamethasone (d). The lowercase 'd' indicates dexamethasone at a lower dose than older myeloma regimens, which used a capital 'D' for high-dose dexamethasone.
VCd uses the same two medicines — bortezomib and dexamethasone — but substitutes cyclophosphamide for lenalidomide.
Both regimens are included in NCCN and ESMO guidelines as standard first-line combinations for newly diagnosed multiple myeloma.
How long does myeloma treatment last?
Myeloma treatment is planned in phases that together can span several years — not the short, fixed course most people expect from chemotherapy.
The first phase, called induction, uses VRd or VCd in repeating cycles to bring the disease under control. After induction, some patients go on to a stem cell transplant. Others move directly to a maintenance phase.
Maintenance uses one or two medicines at lower intensity to keep the myeloma suppressed, and can continue for years. Your oncologist will explain the timeline and when they will stop to reassess.
Who these regimens are not suitable for
These regimens are not appropriate for everyone with a myeloma diagnosis. Eligibility is decided by an oncologist on the individual case, taking into account the full clinical picture.
- Lenalidomide, used in VRd, is not given during pregnancy. It requires a mandatory pregnancy prevention programme for anyone who can become pregnant.
- Bortezomib is not appropriate for patients with pre-existing severe peripheral neuropathy, as it can significantly worsen nerve damage.
- Neither regimen is given to patients with uncontrolled active infection at the time of planned treatment.
- Patients with significantly impaired kidney function may not tolerate lenalidomide without close monitoring — the treating team decides this individually for each patient.
- These regimens are not used for MGUS (monoclonal gammopathy of undetermined significance) or smouldering myeloma that has not yet met criteria for treatment.
When is VCd used instead of VRd?
VRd is more broadly recommended as the starting regimen for newly diagnosed myeloma in patients eligible for intensive treatment, according to NCCN and ESMO guidelines.
VCd is often chosen when lenalidomide is not appropriate — for example in patients with significantly impaired kidney function, where lenalidomide requires close monitoring.
Both regimens contain bortezomib and dexamethasone, so side effects associated with those medicines — including peripheral neuropathy and steroid effects — are present in both. Tell your team early if you notice any nerve symptoms.
Did you know?
This is part of why the side effect profile of these regimens differs from what many people picture when they hear the word chemotherapy.
Source: NCCN Guidelines for Multiple Myeloma
What families ask about these regimens
Why does treatment keep going when things seem to be working?
Myeloma cells often persist in small numbers even when the disease appears controlled. Continuing treatment in a maintenance phase is intended to keep those remaining cells suppressed. Your team monitors response through blood tests — including a protein called paraprotein or M-protein — and imaging at intervals. If the disease responds well, treatment continues. If it changes, the plan changes too. Treatment continuing is not a sign the disease is not under control — it is how myeloma is managed.
What is the difference between induction and maintenance?
Induction is the intensive first phase, using VRd or VCd in full cycles to bring the myeloma under control as quickly as possible. Maintenance is the longer, lower-intensity phase that follows — usually one or two medicines at reduced frequency, continued for years to hold that control. Your oncologist will tell you when the plan moves from one phase to the other, and what they are watching for at each reassessment point.
What side effects should I watch for and report early?
Bortezomib is associated with peripheral neuropathy — tingling, numbness or burning in the hands and feet. Tell your team as soon as you notice this, because catching it early affects how it is managed. Dexamethasone commonly causes sleep difficulty, mood changes, fluid retention and blood sugar changes. Lenalidomide, present in VRd, requires a mandatory pregnancy prevention programme for anyone who can become pregnant. Your team will go through each medicine's profile before you start.
Does everyone with myeloma have a stem cell transplant?
No. Stem cell transplant is considered for patients fit enough for the procedure and whose disease has responded adequately to induction. Patients who are older, have other significant health conditions, or whose disease has not responded well may not be transplant candidates. Being told a transplant is not part of your plan is not a measure of how serious your disease is — it is a clinical decision about what is safe and likely to help for your specific situation.
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Frequently asked questions
Why is the 'd' lowercase in VRd and VCd?
The lowercase 'd' indicates dexamethasone at a lower dose than older myeloma regimens used. Those older protocols used high-dose dexamethasone, shown as a capital 'D'. Current NCCN and ESMO guidelines recommend the lower-dose version, which is better tolerated. You may see both spellings on different documents — they refer to the same medicine at different dose levels, and modern regimens use the lower one.
What is bortezomib and how is it given?
Bortezomib is a proteasome inhibitor — it works by blocking a protein-disposal system inside myeloma cells that they need to survive. It is not a traditional chemotherapy drug. It is given by injection, usually under the skin, on specific days within each treatment cycle. The injections are given in the clinic. How often it is given depends on which phase of treatment you are in and which cycle you are on.
What blood tests are done during myeloma treatment?
Your team will check full blood counts before each cycle to confirm it is safe to continue. They will also measure paraprotein — the abnormal protein produced by myeloma cells — at regular intervals to track how the disease is responding. Kidney function, liver function and calcium are checked periodically. These results together tell your oncologist whether treatment is working, whether it needs adjusting, and whether it is safe to proceed.
What is maintenance therapy and how long does it last?
Maintenance uses one medicine — typically lenalidomide or bortezomib — at lower intensity than during induction, to keep myeloma suppressed after the initial response. How long it lasts is not decided in advance. NCCN and ESMO guidance recommends continuing until the disease progresses or side effects make it unsustainable. Your oncologist will review the plan at regular intervals and explain what they are watching for at each review.
Can myeloma treatment be given as day care?
Yes, in most cases. Induction cycles and bortezomib injections are typically given in a day care setting — you attend for treatment and go home the same day. Oral medicines, including lenalidomide, are taken at home on specific days of the cycle. Stem cell transplant, if it is part of the plan, requires a hospital admission. Your team will explain which parts of treatment need clinic visits and which you manage at home.
Is multiple myeloma treatable?
Multiple myeloma is treatable. ESMO notes that treatment combinations including proteasome inhibitors like bortezomib have changed the condition's outlook substantially over the past two decades. It is not yet considered curable in most patients, but many people live with it as a managed long-term condition. The aim of treatment is to control the disease, reduce symptoms and maintain quality of life. Your oncologist can tell you what the plan is intended to achieve for your specific situation.
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