RVD – Regimen Overview
RVD stands for:
R – Revlimid (lenalidomide)
V – Velcade (bortezomib)
D – Dexamethasone
It is a standard triplet regimen used in multiple myeloma for both:
- Induction therapy (newly diagnosed, transplant-eligible or ineligible patients)
- Relapsed/refractory disease
Components & Mechanisms
| Drug | Mechanism of Action | Route | Key Toxicities |
|---|---|---|---|
| Lenalidomide | Immunomodulatory (IMiD), anti-angiogenic, induces apoptosis | PO | Myelosuppression (neutropenia, thrombocytopenia), risk of thromboembolism, rash |
| Bortezomib | Proteasome inhibitor (reversible 26S proteasome inhibition) | SC or IV | Peripheral neuropathy, thrombocytopenia, GI upset, herpes zoster reactivation |
| Dexamethasone | Corticosteroid, anti-inflammatory, cytotoxic to plasma cells | PO/IV | Hyperglycemia, insomnia, mood changes, infection risk |
Typical Dosing (Example – Induction)
Lenalidomide: 25 mg PO daily on days 1–21 of a 28-day cycle
Bortezomib: 1.3 mg/m² SC or IV on days 1, 4, 8, 11 of a 21-day cycle (or weekly in some regimens)
Dexamethasone: 20–40 mg PO weekly or divided doses
Dose modifications are made for renal impairment, age, or toxicity.
Supportive Measures
- Antiviral prophylaxis: Acyclovir (to prevent herpes zoster reactivation from bortezomib)
- Thromboprophylaxis: Aspirin, LMWH, or DOAC depending on VTE risk
- Growth factor support if neutropenia occurs
Clinical Notes
- RVD is highly effective for newly diagnosed multiple myeloma.
- RVD-lite regimens exist for frail or elderly patients.
- Can be used pre-transplant as induction before autologous HSCT.
- Monitoring: CBC, renal function, neuropathy, blood glucose, infection risk.