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Bortezomib, lenalidomide and daratumumab explained | CION Cancer Clinics
Bortezomib, lenalidomide and daratumumab are three main myeloma medicines, and each attacks myeloma cells differently. Bortezomib is an injection that overloads the cell with its own protein. Lenalidomide is a capsule that disrupts the cell's surroundings and stirs the immune system. Daratumumab is an antibody that marks the cells for destruction. Knowing which causes which side effect helps you report problems early and clearly. At CION Cancer Clinics, our haematology team plans myeloma and lymphoma care with you, discussed at a tumour board and explained in plain words.
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Medically reviewed by Dr. Basudev PokhrelConsultant Haematologist · last reviewed September 2026, next review due September 2027
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On this page
- What do bortezomib, lenalidomide and daratumumab do?
- What should you watch for with each medicine?
- How is each one given, and what does that mean day to day?
- What checks happen before and during treatment?
- What do people often believe about these medicines?
- Who might not be given one of these, and what can this page not tell you?
- Common questions about bortezomib, lenalidomide and daratumumab
The short answer
What do bortezomib, lenalidomide and daratumumab do?
They are three of the main medicines used against myeloma, and each attacks the myeloma cells in a different way. That is why they are usually given together, or in pairs, with a steroid called dexamethasone.
Why three different medicines
Myeloma cells are plasma cells that have gone wrong. They make large amounts of abnormal protein and crowd the bone marrow. Bortezomib jams the machinery the cell uses to clear away that protein, so the cell is overwhelmed. Lenalidomide changes how the myeloma cell and the surrounding marrow talk to each other, and wakes up parts of the immune system. Daratumumab is an antibody that sticks to a marker called CD38 on the myeloma cell and flags it for the immune system to destroy.
Why this matters to you
Because they work differently, their side effects are different too. Knowing which medicine causes which problem helps you tell the team exactly what is happening. It also explains why one medicine can be changed while the others carry on.
Where you will meet them
You are most likely to see them in the first treatment after diagnosis, in combinations written as VRd or DRd. Lenalidomide on its own is often continued for a long time after that, as maintenance. If the myeloma returns later, the same medicines may be used again in a new combination, or swapped for others. Keep a written list of every medicine you have had, with the months you had it.
This page names medicines but gives no doses. Only your haematologist can set or change a dose.One by one
What should you watch for with each medicine?
These are the effects most often reported. You will not have all of them, and some people have very few.
Bortezomib
A small injection under the skin, usually at the clinic.
Tell the team about
- Numbness, tingling or burning in the feet or hands
- Dizziness when standing up
- A painful blistering rash, which may be shingles
- Loose motions or constipation
Lenalidomide
A capsule taken at home on set days of each cycle.
Tell the team about
- A swollen, painful calf or sudden breathlessness
- Fever, sore throat or unusual bruising
- An itchy rash
- Loose motions that keep going
Daratumumab
A drip or an injection under the skin, given in day-care.
Tell the team about
- Cough, wheeze, chills or a blocked nose during the first dose
- Chest infections and fever
- Any planned blood transfusion
Dexamethasone alongside
The steroid partner in most combinations. It is an active treatment, not only a helper.
Tell the team about
- High sugar readings, especially if diabetic
- Poor sleep, restlessness or low mood
- Stomach burning
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How is each one given, and what does that mean day to day?
Medicine
What it means for you
Bortezomib: injection under the skin at the clinic
Short visits on set days. The injection site may be red for a day or two.
Lenalidomide: capsule at home
No visit needed on tablet days, but strict storage and pregnancy rules apply.
Daratumumab: drip or injection under the skin
The first dose takes longest. Later visits are shorter and more spaced out.
Dexamethasone: tablet at home
Usually taken in the morning so it disturbs sleep less.
Staying safe
What checks happen before and during treatment?
Before the first dose
Blood counts, kidney and liver tests, sugar, a hepatitis B check and a blood group sample. Tell the team about any tingling you already have and every medicine you take, including ayurvedic ones.
Preventive medicines
With bortezomib, an antiviral against shingles is usual. With lenalidomide, a blood thinner or aspirin against clots is usual. With daratumumab, medicines before the dose lower the chance of a reaction.
Before each cycle
Counts and kidney tests are repeated. If counts are low or a side effect is building, the team may pause or lower a dose. That is a normal adjustment, not a failure.
Checking the response
M-protein and light chain tests are repeated at intervals. A steady fall tells the team the combination is working for you.
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Commonly believed
What do people often believe about these medicines?
"The tingling in his feet will go away on its own, so there is no need to mention it."
Nerve damage from bortezomib is easier to limit when it is reported early. The team can change how often it is given or adjust the dose. Left unreported, it can become lasting and affect walking and balance.
"Daratumumab is an antibody, so it is gentler and infection is not a worry."
Daratumumab lowers some of the body's own defences too. Chest infections are a known problem. Fever on any of these medicines needs a same-day call, and flu and pneumonia vaccines are usually recommended.
"Lenalidomide capsules can be opened or shared if someone else in the family has myeloma."
Never open, crush or share the capsules. Lenalidomide can cause serious birth defects, so women who could become pregnant should not handle them bare-handed. Return unused capsules as the pharmacy advises.
"If a side effect is bad, we should stop the tablet ourselves until the next visit."
Call the team first. Some effects need the medicine paused; others need a different fix, such as a stomach medicine or a sugar check. Deciding at home can leave the myeloma untreated or miss a real emergency.
Being straight with you
Who might not be given one of these, and what can this page not tell you?
Not everyone receives all three. The choice depends on your body as much as on the myeloma.
When bortezomib may be a poor fit
If there is already marked numbness in the feet, perhaps from long-standing diabetes, the team may prefer a combination without bortezomib or give it less often.
When lenalidomide needs care
Poor kidney function means the dose must be adjusted. A recent clot, or a high clot risk, needs a careful plan. Pregnancy is an absolute bar.
When daratumumab needs care
Severe long-term lung conditions such as COPD or asthma need extra planning because of breathing reactions. Cost and scheme coverage may also affect access, so ask early.
What the medicine name cannot tell you
Knowing which medicines you are on says nothing on its own about how the myeloma will respond. That depends on its stage, its genetic features and how it behaves over the first months. At CION, the haematology team reviews each case at a tumour board. Ask your haematologist what response they expect to see, and by when.
Questions we are asked
Common questions about bortezomib, lenalidomide and daratumumab
Are these chemotherapy?
Not in the traditional sense. Bortezomib and lenalidomide are targeted anti-myeloma medicines, and daratumumab is an antibody treatment. They still lower blood counts and raise infection risk, so the same care around fever and hygiene applies. Hair loss is much less common than with older chemotherapy medicines.
Why does the first daratumumab dose take so long?
Reactions such as cough, chills or a blocked nose are most likely during the first dose. It is given slowly, with medicines beforehand, and nurses watch closely. Plan to spend most of the day at the clinic. Later doses usually go faster once the body has seen the medicine.
Can lenalidomide be taken with food?
Follow the instructions printed on your own prescription and pharmacy leaflet, because they are written for your schedule. Swallow the capsule whole with water, at about the same time each day. If a capsule is missed, ask the team what to do rather than doubling up on the next one.
Will the numbness from bortezomib be permanent?
For many people it improves over months once the dose is changed or treatment stops, but it does not always go fully. Reporting it early gives the best chance of limiting it. Tell the team about trouble with buttons, walking on uneven ground or burning pain at night.
Can my mother take her diabetes and blood pressure medicines too?
Usually yes, but bring every medicine and supplement to the first visit so the team can check for problems. Dexamethasone often pushes sugar up, so her diabetes medicines may need adjusting by her doctor. Some blood pressure medicines add to dizziness on bortezomib days. Do not change anything on your own.
Why must I tell the blood bank I am on daratumumab?
Daratumumab sticks to red cells in blood-matching tests and can make every donor unit look incompatible. The laboratory has ways around it, but only if it knows. Carry a note saying you are on daratumumab and show it before any transfusion, at any hospital.
Can men on lenalidomide father a child?
Lenalidomide can pass into semen. Men are asked to use condoms during treatment and for a period after it, even after a vasectomy. Women who could become pregnant need reliable contraception and pregnancy tests. The pharmacy and the team will explain the current rules clearly before you start.
Are these medicines covered by Aarogyasri or insurance?
Coverage depends on the scheme, the treatment package and the current rules, which change. Aarogyasri, PM-JAY, CGHS, ECHS, EHS and cashless insurance may each cover some parts. Bring your scheme card and policy details, and ask the team to check your cover before the plan is fixed.
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Sources
- National Cancer Institute — Plasma Cell Neoplasms (Including Multiple Myeloma) Treatment (PDQ), Patient Version
- Macmillan Cancer Support — Myeloma
- American Cancer Society — Multiple Myeloma
- Leukemia & Lymphoma Society — Myeloma
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Induction Therapy: VRd, DRd and What They InvolveHow these medicines are combined in the first treatmentNumbness and tingling from myeloma treatmentManaging nerve effects from bortezomibMaintenance Therapy After Myeloma TreatmentLenalidomide as long-term treatmentInfection and Vaccination in MyelomaLowering infection risk during treatment
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