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Treatment Name: RVd (Revlimid® + Velcade® + dexamethasone)
RVd (Revlimid® + Velcade® + dexamethasone) is a Chemotherapy Regimen for Multiple Myeloma (MM)
How does RVd work?
Each of the medications in the RVd regimen is designed to kill or slow the growth of myeloma cells.
R - Revlimid® (lenalidomide)
V - Velcade® (bortezomib)
d - dexamethasone (Deltasone, dex)
Alternative name: VRd
V - Velcade® (bortezomib)
R - Revlimid® (lenalidomide)
d - dexamethasone (Deltasone, dex)
Goals of therapy:
RVd or VRd is given to alleviate myeloma symptoms and slow the progression of multiple myeloma, not to cure this disease. After treatment, patients who respond to RVd typically are either monitored, continue on to maintenance therapy, or proceed to bone marrow transplant.
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Schedule
- Lenalidomide (Revlimid®) 25 mg by mouth daily for 14 days continuously on Days 1 - 14
- Bortezomib subcutaneous injection on Days 1, 4, 8, and 11
- Dexamethasone:
- 40 mg (ten 4 mg tablets) by mouth on Days 1, 8, and 15
Or
- 20 mg (five 4 mg tablets) by mouth on Days 1, 2, then 4, 5, then 8, 9, then 11, 12
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)
Bortezomib is usually given in an outpatient infusion center, allowing the person to go home afterwards. Lenalidomide and dexamethasone are usually taken at home.
RVd is repeated every 21 days. This is known as one Cycle. Each cycle may be repeated up to eight times, depending upon the stage of the disease. Duration of therapy may last up to 8 months, depending upon response, tolerability, and number of cycles prescribed.
Click here for common RVd starting doses.
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Side Effects
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 with RVd are shown here:
Approximately 5 - 19% of patients discontinue RVd due to unacceptable side effects.
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Monitoring
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), serum protein electrophoresis (SPEP), urine protein electrophoresis (UPEP), 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 affect treatment?
Depending upon the results, your doctor may advise to continue chemotherapy as planned, or delay or switch therapy.
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ChemoExperts Tips
- Bortezomib can cause reactivation of herpes (HSV- herpes simplex virus) or varicella zoster virus (VZV), which causes shingles. Prophylactic (preventative) anti-viral medications such as acyclovir (Zovirax®), valacyclovir (Valtrex®), or famciclovir (Famvir®) should be taken during treatment
- Additional medications that may be prescribed include Bactrim® (Sulfamethoxazole/Trimethoprim, 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 RVd (Revlimid® + Velcade® + 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 RVd (Revlimid® + Velcade® + dexamethasone). Depending upon your income, they may be able to help cover the cost of:
- Revlimid®
- Velcade®
- Dexamethasone
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 RVd (Revlimid® + Velcade® + 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.
Emotional Wellness
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 RVd (Revlimid® + Velcade® + dexamethasone)
What is Multiple Myeloma (MM)?
Multiple Myeloma is a disease of the white blood cells, called plasma cells, found in the blood or bone marrow. Plasma cells are a type of white blood cell known as a B-lymphocyte.
Sometimes plasma cells form collections on bone and weaken or destroy it. These are known as "lytic lesions". Multiple Myeloma is a rare condition with an unknown cause. The stage can vary at diagnosis and throughout treatment. Staging is based on the international staging system (ISS). The type and effectiveness of the treatment may depend upon the stage.
NOTE: Treatment Options listed below are not all-inclusive. Other treatments may be available. ChemoExperts provides drug information and does not recommend any one treatment over another. Only your Doctor can choose which therapy is appropriate for you.
What is a Teratogen?
A drug that is known to cause severe birth defects or fetal death. These drugs should NOT be used during pregnancy and patients should avoid becoming pregnant while taking these drugs.
Women, if taking a teratogenic medication, should abstain from heterosexual intercourse or use two forms of reliable contraception at least 4 weeks prior to, during, and for 4 weeks after treatment.
Males (even after vasectomy), if taking a teratogenic medication, must use a latex or synthetic condom during any sexual contact with women of childbearing potential and must not donate sperm for up to 28 days following discontinuation of therapy.
What is the Revlimid® REMS program?
REMS stands for Risk Evaluation and Mitigation Strategy. This program requires that all patients must sign a Patient-Physician agreement form acknowledging risks with pregnancy before starting treatment.
If you are woman who can get pregnant, you must have 2 negative pregnancy tests before starting lenalidomide (Revlimid®) and will have pregnancy tests performed periodically throughout treatment. Lenalidomide is only dispensed from certain pharmacies and the pharmacy will contact you before every prescription is dispensed.
A confidential survey must also be taken every month before lenalidomide can be dispensed.
Clinical Studies
If you are interested in reading the clinical trials results, please click on references below:
1. Kumar S, Flinn I, Richardson PG, et al. Randomized, multicenter, phase 2 study (EVOLUTION) of combinations of bortezomib, dexamethasone, cyclophosphamide, and lenalidomide in previously untreated multiple myeloma. Blood. 2012;119:4375-4381.
2. Richardson, PG, Xie W, Jagannath S, et al. A phase 2 trial of lenalidomide, bortezomib, and dexamethasone in patients with relapsed and relapsed/refractory myeloma. Blood. 2014;123:1461-1469.
What is a CBC?
A Complete Blood Count (CBC) is a frequently ordered blood test that tells clinicians the status of your: 1) White blood cell count, 2) Hemoglobin, and 3) Platelet count at the time the test was taken.
Common uses:
1) White blood cell count (WBC): is used to determine infection risk, or response to chemotherapy. Certain chemotherapy agents may harm our good infection-fighting cells. Sometimes chemotherapy may need to be delayed to allow these cells to recover.
2) Hemoglobin: is used to determine if someone is anemic. Anytime the hemoglobin is below 12 g/dL, the person is said to be anemic. Red blood cell transfusions, and sometimes iron can be given to restore the hemoglobin level, but anemia treatment should always aim at treating the underlying cause or condition.
3) Platelet count: is used to determine if the risk of bleeding is increased or if a platelet transfusion is required to prevent bleeding. Certain medications that increase bleeding risk, such as: aspirin, certain chemotherapy agents, and blood thinners, may need to be stopped temporarily until the platelet count is within a safe range.
What is a CMP?
A Comprehensive Metabolic Panel (CMP) is a frequently ordered blood test that tells clinicians the status of your: 1) Electrolytes & Acid/Base status, 2) Kidney function, 3) Liver function, 4) Blood sugar, and 5) Calcium at the time the test was taken. It is commonly used to monitor liver and kidney function when beginning new medications such as chemotherapy. A total of 14 tests are run simultaneously and are shown below.
Electrolytes & Acid/Base status:
1) Sodium, 2) Potassium, 3) Carbon dioxide, 4) Chloride
Kidney Function:
5) BUN (blood urea nitrogen), 6) Serum creatinine (Scr)
Liver Function:
7) AST, 8) ALT, 9) Total bilirubin, 10) Alk Phos, 11) Albumin, 12) Total protein
Blood sugar:
13) Serum glucose
Calcium:
14) Serum calcium
Common Starting Doses
- Lenalidomide 25 mg by mouth daily for 14 days continuously, Days 1 - 14
- Bortezomib 1.3 mg/m2 subcutaneous injection on Days 1, 4, 8, and 11
- Dexamethasone 40 mg (ten 4 mg tablets) by mouth on Days 1, 8, and 15
OR
- Dexamethasone 20 mg (five 4 mg tablets) by mouth on Days 1, 2, 4, 5, 8, 9, 11, 12
Note: individual doses may vary based upon your Doctor's recommendation, or drug availability.
What does Cure mean?
The word “cure” means there are no cancer cells left in the body and cancer will never come back. Depending on the cancer type and stage, this may be the true goal of therapy. However, it is very difficult to prove all cancer cells are gone. Even though images, like X-rays and MRI’s, and blood tests may not show any signs of cancer, there can be a small amount of cancer cells still left in the body. Because of this, the word “remission” is used more often. This means there are no signs or symptoms of cancer. Patients in remission are followed closely for any signs of cancer returning. Sometimes, more chemotherapy may be given while in remission to prevent the cancer from coming back.
Doctors usually do not consider a patient “cured” until the chance of cancer returning is extremely low. If cancer does return, it usually happens within 5 years of having a remission. Because of this, doctors do not consider a patient cured unless the cancer has not come back within 5 years of remission. The five-year cutoff does not apply to all cancers.
Fatigue 
Diarrhea
Pain
Bleeding
Anemia
Constipation
Nausea and Vomiting
Neutropenic Fever
Blood Clots