Multiple myeloma RVd (lenalidomide bortezomib dexamethasone) overview page

Newly diagnosed multiple myeloma patients (MM) who are eligible for autologous stem cell transplantation (ASCT) 

Frequency: 21 days

Cycles: 4

Lenalidomide 25 mg PO D1-14

Bortezomib 1.3 mg/m² SC D1,4,8,11

Dexamethasone 20 mg PO D1,2,8,9,15,16

Frequency: 21 days

Cycles: 2 post-ASCT

Lenalidomide 25 mg PO D1-14

Bortezomib 1.3 mg/m² SC D1,4,8,11

Dexamethasone 20 mg PO D1,2,8,9,15,16

It is consensus of the Haematology Reference Committee that maintenance lenalidomide should be given as per local institution standard of care, for post-ASCT, see ID 3797 Multiple myeloma lenalidomide maintenance post autologous transplant for more information.

Newly diagnosed MM patients who are eligible for ASCT

Frequency: 21 days

Cycles: 3

Lenalidomide 25 mg PO D1-14

Bortezomib 1.3 mg/m² SC D1,4,8,11

Dexamethasone 20 mg PO D1,2,4,5,8,9,11,12

Frequency: 21 days

Cycles: 2 post-ASCT or 5 (RVd alone - no transplant)

Lenalidomide 25 mg PO D1-14

Bortezomib 1.3 mg/m² SC D1,4,8,11

Dexamethasone 10 mg PO D1,2,4,5,8,9,11,12

It is consensus of the Haematology Reference Committee that maintenance lenalidomide should be given as per local institution standard of care, for post-ASCT, see ID 3797 Multiple myeloma lenalidomide maintenance post autologous transplant for more information.

Newly diagnosed multiple myeloma

Frequency: 28 or 35 days

Cycles: Up to 6

Lenalidomide 25 mg PO D1-21

Bortezomib 1.3 mg/m² SC D1,8,15,22

Dexamethasone 20 mg PO D1,2,8,9,15,16,22,23 *

* 20 mg/week of dexamethasone should be considered as a starting dose in patients > 75 years

None

It is consensus of the Haematology Reference Committee that:

• maintenance lenalidomide should be given as per local institution standard of care, for post-ASCT, see ID 3797 Multiple myeloma lenalidomide maintenance post autologous transplant for more information.
• lenalidomide +/- dexamethasone can be continued at the discretion of the clinician as per the SWOG S0777 and RVd-lite protocols for transplant ineligible patients

Newly diagnosed MM patients who are eligible for ASCT

Frequency: 28 days

Cycles: 6

Lenalidomide 25 mg PO D1-21

Bortezomib 1.3 mg/m² SC D1,4,8,11

Dexamethasone 40 mg PO D1-4 and D9-12

Frequency: 28 days

Cycles: 2 post-ASCT

Lenalidomide 25 mg PO D1-21

Bortezomib 1.3 mg/m² SC D1,4,8,11

Dexamethasone 40 mg PO D1-4 and D9-12

None

Newly diagnosed MM patients

Frequency: 21 days

Cycles: 8

Lenalidomide 25 mg PO D1-14

Bortezomib 1.3 mg/m² SC D1,4,8,11

Dexamethasone 20 mg PO D1,2,4,5,8,9,11,12

None

Frequency: 28 days

Cycles: on-going

Lenalidomide 25 mg PO D1-21

Dexamethasone 40 mg PO D1,8,15,22

Newly diagnosed MM patients who are transplant ineligible

Frequency: 35 days

Cycles: 9

Lenalidomide 15 mg PO D1-21

Bortezomib 1.3 mg/m² SC D1,8,15,22

Dexamethasone:

≤ 75 yr: 20 mg PO D1,2,8,9,15,16,22,23 

> 75 yr: 20 mg PO D1,8,15,22 

Frequency: 28 days

Cycles: 6

Lenalidomide 15 mg PO D1-21

Bortezomib 1.3 mg/m² SC D1,15

Lenalidomide maintenance was not mandated in this protocol but was continued at at the discretion of the investigator at lenalidomide 10 mg PO continuous until disease progression or unacceptable toxicity.

RVd weekly INTERIM protocol treatment schedule updated: dexamethasone days of administration changed to align with RVd premium lite schedule as reported in McCaughan et al. 2022.
Version number changed to V.3.

RVd protocols reviewed and discussed at 2024 multiple myeloma reference committee meeting.

• New RVd weekly INTERIM protocol developed and approved for inclusion on eviQ. Added to Multiple myeloma RVd (lenalidomide bortezomib dexamethasone) overview page
• GRIFFIN and IFM maintenance protocols superseded per eviQ Haematology Reference Committee consensus. Replaced by ID 3797 Multiple myeloma lenalidomide maintenance post autologous transplant to align lenalidomide maintenance across the eviQ transplant-eligible RVd pathways
• Note regarding RVd-lite maintenance updated to align with ID 3922 Multiple myeloma maintenance RVd-lite lenalidomide protocol
• Version number changed to V.2.

• Link to Medical Scientific Advisory Group (MSAG) Clinical Practice Guideline Multiple Myeloma updated

Review in 2 years.