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VRd and Dara-VRd (myeloma induction regimens)

aka VRd, RVd, Dara-VRd, D-VRd, Isa-VRd, Dara-Rd, DRd, KRd, Dara-KRd, VMP, Dara-VMP, VCd, bortezomib-based, lenalidomide-based, CD38 antibody + PI + IMiD, PI + IMiD + dexamethasone

The alphabet soup of myeloma treatment: V (bortezomib, Velcade), R (lenalidomide, Revlimid), d (dexamethasone), Dara (daratumumab), Isa (isatuximab), K (carfilzomib). Dara-VRd, a four-drug quadruplet, is now the standard first treatment for most patients.

VRd was the standard triplet for a decade (SWOG S0777). Adding a CD38 antibody made quadruplets standard: Dara-VRd before and after autologous transplant (PERSEUS) and in transplant-ineligible patients (CEPHEUS), Isa-VRd in IMROZ, with Dara-Rd (MAIA) for frailer patients. Bortezomib causes neuropathy and is often dropped after induction; lenalidomide continues as maintenance. MRD negativity rates above 60% with quadruplets are prompting trials of MRD-guided de-escalation and of CAR-T or bispecifics in place of transplant (CARTITUDE-5/6).

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Treatment jargon

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