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Induction therapy for myeloma: VRd, DRd and what they involve | CION Cancer Clinics
VRd and DRd are the two combinations most often used as the first treatment for myeloma, called induction. VRd is bortezomib, lenalidomide and dexamethasone. DRd swaps bortezomib for daratumumab. Which one you get depends mainly on whether a stem cell transplant is planned, and on your kidneys, nerves and fitness. Most treatment is day-care visits and tablets at home, with regular blood tests. 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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The short answer
What is induction therapy for myeloma?
Induction is the first block of treatment after a myeloma diagnosis. Its job is to bring the myeloma under control quickly, so that the bones, kidneys and blood counts get a chance to recover.
Why the name sounds odd
"Induction" simply means the treatment that starts things off. It is usually a combination of three or four medicines given in repeating blocks called cycles. VRd and DRd are the two combinations you are most likely to see written on a treatment plan in India today. The letters are shorthand for the medicines inside them.
What decides which one you get
The biggest question is whether a stem cell transplant is planned later. If it is, induction usually runs for a few months and then stops so your own stem cells can be collected. If a transplant is not planned, the combination is often continued for much longer. Your kidney function, nerve health, other illnesses, the genetic features of the myeloma and what the family can manage all shape the choice.
What it asks of you
Most of it is given as day-care visits and tablets at home. You will need regular blood tests, and someone at home should know which symptoms mean a same-day call.
This page explains the combinations. It does not give doses. Your haematologist sets the dose and schedule for your body.Decoding the letters
What do VRd and DRd actually contain?
Each letter is a medicine. The small "d" is a steroid that appears in almost every myeloma combination.
VRd
Bortezomib, lenalidomide and dexamethasone. Bortezomib is a small injection under the skin, lenalidomide is a capsule taken at home, and dexamethasone is a steroid tablet.
Often chosen when
- A transplant is being considered
- The kidneys need a quick response
DRd
Daratumumab, lenalidomide and dexamethasone. Daratumumab is an antibody given as a drip or an injection under the skin in the day-care unit.
Often chosen when
- A transplant is not planned
- Nerve damage makes bortezomib a poor fit
Four-drug versions
Some teams add daratumumab to VRd, written D-VRd or Dara-VRd. It is more treatment, with more visits and more infection risk, and it is used mainly in people fit enough for a transplant.
Other combinations
You may see VCd, which swaps lenalidomide for cyclophosphamide. It is sometimes used first when the kidneys are badly affected or when cost or supply is a problem.
A different combination is not a weaker plan. It is a plan fitted to you.Not sure whether this applies to you?
Ask an oncologistWeek by week
What does induction actually involve?
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Tests before the first cycle
Blood counts, kidney and liver tests, calcium, a blood group check and often an ECG. If daratumumab is planned, the blood bank is told first, because it can confuse later blood-matching tests.
-
Day-care visits
Bortezomib or daratumumab is given at the clinic. Early visits take longer because you are watched for reactions. Later visits are usually shorter.
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Tablets at home
Lenalidomide and dexamethasone are taken at home on set days of the cycle. You will be given a written calendar. Keep it where the whole family can see it.
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Preventive medicines
Most people are given a blood thinner or aspirin against clots, an antiviral against shingles, and sometimes an antibiotic. These are part of the plan, not extras.
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Checking the response
After every cycle or two, the M-protein or light chain blood tests are repeated. Falling numbers show the myeloma is responding. If a transplant is planned, stem cell collection is arranged after the planned number of cycles.
On your plan
Which words will you see on the treatment plan?
- Cycle
- One repeating block of treatment, including the rest days. The plan says how many are intended.
- Transplant-eligible
- The team thinks you are fit enough for a stem cell transplant after induction. It is about fitness, not age alone.
- M-protein or paraprotein
- The abnormal protein made by myeloma cells. Its level is the main way response is tracked.
- Response (PR, VGPR, CR)
- How far the myeloma markers have fallen: partial, very good partial or complete response.
- Stem cell harvest
- Collecting your own stem cells from the blood, before the lenalidomide exposure gets too long.
- Dexamethasone
- A steroid that helps the other medicines work. It can raise blood sugar and disturb sleep.
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Commonly believed
What do families often get wrong about induction?
"DRd is newer, so it must be stronger than VRd."
Both are standard, well-studied combinations. They suit different people. A combination is chosen for your kidneys, nerves, transplant plan and overall fitness, not for being the most recent.
"Steroids are only for pain, so we can skip the dexamethasone."
Dexamethasone is an active part of the treatment against myeloma. If its effects on sleep, mood or sugar are hard to bear, tell the team. They can adjust it. Please do not change it at home.
"Tablets at home means the treatment is mild."
Lenalidomide is a strong anti-cancer medicine. It lowers blood counts, raises the risk of clots and must never be taken during pregnancy. Store it safely, away from children, and do not share it.
"If the report looks better after one cycle, we can stop."
An early fall in M-protein is good news, but induction is planned as a full block. Stopping early usually lets the myeloma recover. The decision to stop belongs with your haematologist.
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When not to wait for the next visit
A fever or shivering during induction, a swollen and painful calf on one side, sudden breathlessness or chest pain, or new weakness in the legs needs care the same day. Go to the nearest emergency department or call 108, and say the person is on myeloma treatment. Carry the treatment calendar with you.
Being straight with you
What can this page not tell you?
The name of a combination tells you nothing about how your myeloma will do. Two people on the same VRd plan can respond very differently. Your outlook depends on the stage, the genetic features of the myeloma cells, your kidneys, your general health and how the disease responds over the first few cycles.
Who these combinations may not suit
Bortezomib may be a poor fit if you already have numbness or tingling in the feet from diabetes. Lenalidomide needs care if the kidneys are working poorly or if there has been a recent clot. Very frail or older people often start on lighter versions with lower steroid doses. None of this means treatment is not possible. It means the plan is adapted.
How CION fits in
At CION, the haematology team reviews your reports, presents the case at a tumour board and plans induction with you. Where a stem cell transplant is the next step, the team coordinates referral to a qualified transplant centre. Ask which centre, and when the stem cell collection would be timed.
Bring every report, including the bone marrow biopsy, the electrophoresis report and the kidney tests, to the first visit.Questions we are asked
Common questions about VRd and DRd induction
How long does induction usually last?
If a transplant is planned, induction usually runs for a few months and then pauses for stem cell collection. If a transplant is not planned, a combination such as DRd is often continued for as long as it keeps working and you tolerate it. Your written plan states the intended number of cycles for you.
Is VRd or DRd given as a drip?
Bortezomib is usually a small injection under the skin of the tummy or thigh. Daratumumab may be a drip or an injection under the skin, depending on the form available. Lenalidomide and dexamethasone are taken by mouth at home. Most treatment days are day-care, so you go home the same day.
Will my hair fall out?
Hair loss is not common with VRd or DRd. It is more likely if cyclophosphamide is part of the plan, or later with the high-dose treatment given before a transplant. Tiredness, loose motions, constipation and tingling in the feet are more typical complaints during induction. Tell the team about each one early.
Why is my father on a blood thinner as well?
Lenalidomide, especially together with dexamethasone, raises the chance of a blood clot in the legs or lungs. A preventive blood thinner or aspirin is usually given for that reason. The choice depends on his clot risk and bleeding risk. Do not stop or change it without asking his haematologist first.
Can induction start if the kidneys are damaged?
Often yes, and quickly, because controlling the myeloma is what helps the kidneys recover. Bortezomib-based combinations are commonly used in this situation. Lenalidomide is adjusted for kidney function, which is why kidney tests are repeated regularly. Drink the fluid amount your team advises, not a guess.
What should we tell the blood bank about daratumumab?
Daratumumab can make routine blood-matching tests look confusing, which can delay a transfusion. The team usually sends a blood sample for typing before the first dose. Carry a note or card saying the patient is on daratumumab, and show it at any hospital before a transfusion is arranged.
Can he keep working during induction?
Some people do, especially with desk jobs and a nearby clinic. Dexamethasone days can bring energy and poor sleep, followed by a tired dip. Infection risk means crowded workplaces need care. Talk to the team about the visit calendar before deciding, and plan for flexibility in the early cycles.
Are these medicines covered by Aarogyasri or insurance?
Cover depends on the scheme, the package and the current rules, which change. Aarogyasri, PM-JAY, CGHS, ECHS, EHS and cashless insurance may each cover parts of myeloma treatment. Bring the scheme card and policy details to the first visit, and ask the team to check your cover before the plan is finalised.
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Sources
- National Cancer Institute — Plasma Cell Neoplasms (Including Multiple Myeloma) Treatment (PDQ), Patient Version
- NHS — Multiple myeloma
- Cancer Research UK — Myeloma
- NICE — Myeloma: diagnosis and management (NG35)
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
Bortezomib, Lenalidomide and Daratumumab ExplainedEach medicine in these combinations, one by oneAm I Eligible for a Stem Cell Transplant?The question that shapes which induction you getNumbness and tingling from myeloma treatmentTingling in the feet during bortezomibMultiple MyelomaThe full myeloma guide
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