Overview | Schedule | Side Effects | Monitoring | Tips | Patient Assistance | Emotional Wellness | Drugs | References
Treatment Name: Rd (Revlimid® + Dexamethasone)
Rd (Revlimid® + Dexamethasone) is a Chemotherapy Regimen for Multiple Myeloma (MM)
How does Rd work?
Each of the medications in Rd is designed to kill or slow the growth of myeloma cells.
R – lenalidomide (Revlimid®)
d – dexamethasone (Decadron, dex)
Goals of therapy:
Rd is taken to alleviate myeloma symptoms and slow progression of multiple myeloma, not to cure the disease. After treatment, patients who respond to Rd typically are either monitored, continue on to maintenance therapy, or proceed to bone marrow transplant.
How is Rd therapy for multiple myeloma taken?
- Lenalidomide (Revlimid®) 25 mg by mouth daily for 21 days continuously on Days 1 through 21
- Dexamethasone 40 mg (ten 4 mg tablets) by mouth on Days 1, 8, 15, and 22
Lenalidomide is a human teratogen. In order to decrease the risk of embryo-fetal exposure, lenalidomide is available only through a restricted distribution program (Revlimid® REMS).
Lenalidomide and dexamethasone are both usually taken at home. Rd is repeated every 28 days. This is known as one Cycle. Each cycle may be repeated until the treatment no longer works or until unacceptable side effects occur. Duration of therapy depends upon response, tolerability, and number of cycles prescribed.
What are the most common side effects from Rd for Multiple Myeloma?
In a multi-drug regimen, each medication has unique side effects. When these medicines are given together, drug-related side effects reported in clinical studies give the best estimate of what to expect. In clinical studies, the most commonly reported side effects of Rd are shown here.
- Low white blood cells (20%)
- Blood clot (12%)
- Fatigue (9%)
- Infection (9%)
- Anemia [low red blood cells] (7%)
- High blood sugar (6%)
- Increased bleeding risk [low platelets] (5%)
On average, 19% of patients discontinue treatment due to unacceptable side effects.
Importantly, not all people who experience a side effect from Rd will experience it in the same way. It may be mild in some or severe in others, depending upon the individual. Everybody is different. Additionally, side effects may vary over time. For some, side effects may be a reason to delay or switch treatment, reduce the dose, or avoid treatment with a certain medication altogether.
Side effects may be treatable when they occur or preventable by taking certain medications before they happen. When medications are taken to prevent a problem, this is known as prophylaxis, or "prophy" for short.
After starting treatment with Rd, be sure to come back and watch all of the side effect videos shown below. Each of these videos contain valuable information about side effect management that will hopefully help you to both feel better and stay out of the hospital.
Watch videos on common Rd therapy side effects below
How often is monitoring needed?
Labs (blood tests) may be checked before treatment and periodically during treatment. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), multiple myeloma labs, plus any others your doctor may order.
How often is imaging needed?
Imaging may be checked before treatment and then periodically during treatment to assess how the chemotherapy is working. Imaging may include bone surveys, computerized tomography (CT) scans, magnetic resonance imaging (MRI), or positron emission tomography (PET) scans.
How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue Rd as planned, delay the next dose until the side effect goes away, or switch to an alternative therapy.
Questions to Ask Your...
A better understanding of your treatments will allow you to ask more questions of your healthcare team. We then hope that with the answers, you will get better results and have greater satisfaction with your care. Because we know it's not always easy to know what questions to ask, we've tried to make it easy for you!
Choose any healthcare provider below to see common questions that you may want to ask of this person. Then, either print each list to bring to your clinic visits, or copy the questions and send them as a message to your healthcare team through your electronic medical record.
What are the most important things to know about Rd while receiving therapy?
- A medication to prevent blood clots is usually recommended for everyone receiving the Rd regimen. The exact medicine to prevent blood clots may differ from patient to patient and will be chosen by your doctor
- A dose reduction in lenalidomide (Revlimid®) may be required in certain individuals to help decrease side effects
- Additional medications that may be prescribed include Sulfamethoxazole/Trimethoprim (Bactrim®, unless you have a sulfa allergy) to prevent Pneumocystis Pneumonia and omeprazole (Prilosec®, or a similar medication in that drug class) to prevent ulcers from dexamethasone
- A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately.
- Clinical trials may exist for multiple myeloma. Ask your doctor if any studies are currently enrolling in your area. If not, go to clinicaltrials.gov to search for other centers offering study medications
Patient Assistance & Co-payment Coverage
Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for Rd (Revlimid® + Dexamethasone), we have provided links that may help.
Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for Rd (Revlimid® + Dexamethasone). Depending upon your income, they may be able to help cover the cost of:
For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.
- If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.
Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as Rd (Revlimid® + Dexamethasone) and are the best source to help you understand drug cost.
- Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.
What is Emotional Wellness?
Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.
Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.
Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.
Learn more about pursuing emotional wellness while receiving treatment with Rd (Revlimid® + Dexamethasone)