VRd and VCd: — What Your Myeloma Regimen Actually Contains

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.

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.

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.

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.

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.

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.