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Multiple Myeloma an incurable disease, but I have spent the last 25 years in remission using a blend of conventional oncology and evidence-based nutrition, supplementation, and lifestyle therapies from peer-reviewed studies that your oncologist probably hasn't told you about.

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Multiple Myeloma Chemotherapy- “Revlimid Lite” Better Than Heavy-dose Revlimid?

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“Revlimid lite demonstrated high efficacy (for MM) with better tolerability in transplant-eligible patients with NDMM,” compared to full-dose Revlimid.

You’ve been diagnosed with multiple myeloma (MM). You are considering what MM chemotherapy you should undergo as your induction therapy. In addition, your oncologist is pushing an autologous stem cell transplant after your induction. Should you have an ASCT…now…later…?

Remember that MM is an incurable cancer. Living with multiple myeloma is a marathon, not a sprint. 

  • RVd is short for the multiple myeloma chemotherapy regimen called Revlimid (Lenalidomide), Velcade (Bortezomib) and Dexamethasone (dex).
  • RVd is usually considered the standard-of-care for induction therapy of newly diagnosed MM patients. 
  • The treatment duration for SOC induction therapy is usually 3-6 months or 3-6 monthly courses of RVD- it is important to keep in mind that, in my research and opinion, “less is more” if the MM patient achieves CR or MRD- status-
  • The issue between RVd lite and RVd heavy is the risk/reward or side effects caused by the toxicity of this triplet.

According to the article linked below, RVd lite is efficacious AND is better tolerated than full-dose RVd.

A key difference between High-Dose RVd and RVd Lite is that the usual amount of Revlimid (lenalidomide) has been reduced from 25 mg a day to 15 mg a day. By undergoing a lower dose of revlimid, there is a better chance of a positive result from low-dose revlimid maintenance therapy.

According to the study linked below, the ORR or the number of mm patients who respond to RVd lite is more than 80%. This is an excellent ORR.

Of that 80% plus who respond, almost 50% achieve very good partial remission (VGPR).

The issue then, is to understand your prognosis if you achieve VGPR, CR, or even MRD-. Will you live longer, on average, if you achieve one of the acronyms above? While MRD- status is correlated with longer life, is this correlation enough to offset the negatives that come from more toxicity, more chemotherapy?

I’ve never found a study that explains the question above. What I do know, is that less is more in multiple myeloma. At least when it comes to chemotherapy. Please consider:

  • pre-habilitation
  • integrative therapies 
  • complementary therapies

all shown to enhance the efficacy of your RVd lite.

I throw a lot of info at you above and I have probably introduced a lot of MM jargon to you. To learn more about pre-habilitation, integrative therapies and complementary therapies shown to manage multiple myeloma, scroll down the page, post a question or comment and I will reply to you ASAP.

Hang in there,

David Emerson

  • MM Survivor
  • MM Coach
  • Director PeopleBeatingCancer

Recommended Reading:

Common Starting Doses (for heavy dose RVd)-
  • 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.

Modified Bortezomib, Lenalidomide, Dexamethasone Induction Regimen Efficacious, Tolerable for Transplant-Eligible Patients With Newly Diagnosed Multiple Myeloma

“A recent study demonstrated the efficacy and tolerability of a modified induction protocol for patients with newly diagnosed multiple myeloma (NDMM) who are eligible for autologous stem cell transplantation (ASCT)…

According to the study authors, induction with therapy combining bortezomib, lenalidomide, and dexamethasone (full dose VRd) shows high efficacy but with limited tolerability in some patients.

In the VRD lite regimen used in this study:

  • subcutaneous bortezomib (velcade) dosed at 1.3 mg/m2
  • dexamethasone (40 mg) was administered on the days that bortezomib was given.
  • Oral lenalidomide (revlimid) was given at a dosage of 15 mg on days when bortezomib was not given

The authors reported an overall response rate (ORR) of 83%,

with a very good partial response (VGPR) or better rate of 48%.

Patients who completed 4 or more cycles of VRd lite had an ORR of 87% and a VGPR or better rate of 50%.

Of 38 patients who received 4 or more cycles of VRd lite and underwent ASCT, the ORR was reportedly 100%, with a VGPR or better rate of 74%.

  • Lymphocytopenia was reported in 46% of patients,
  • neutropenia in 31%
  • liver dysfunction and peripheral neuropathy each occurred in 27%.
  • Grade 3 neutropenia occurred in 19% of patients, and
  • grade 4 neutropenia occurred in 6%.

Dose modifications were reported in 15.2% of patients in this study.

“In this retrospective analysis, VRd lite demonstrated high efficacy with better tolerability in transplant-eligible patients with NDMM,” the study authors wrote in their report.”

The efficacy and safety of modified bortezomib-lenalidomide-dexamethasone in transplant-eligible patients with newly diagnosed multiple myeloma.

  • “The overall response rate (ORR) after four cycles of VRd lite was 83%,
  • complete response of 25%.

Thirty-eight among the 45 patients who completed at least four cycles of VRd lite received autologous stem cell transplantation (ASCT). The ORR and very good partial response or better were upgraded to 100% and 74%, respectively, following ASCT.

Leave a Comment:

ken marovich says 4 years ago

I joined people besting cancer in 2016 right after I received 4 months of Rvd and went into remission. I have yet to receive news letters from you despite numerous emails to you asking for news letters. Do you still do communication with members?

    David Emerson says 4 years ago

    Hi Ken-

    I replied to your email address earlier today. Let me know if you have any questions.


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