About Your Daratumumab, Revlimid, Velcade, Dexamethasone (D-RVD) Treatment Plan

This video will explain what to expect when getting daratumumab, revlimid, velcade, dexamethasone (D-RVD) treatment plan at MSK.

Multiple myeloma is a type of blood cancer that affects plasma cells.

Plasma cells are a type of white blood cell that live inside the bone marrow.

They make proteins called antibodies. Antibodies help the immune system fight infections.

Treatment for multiple myeloma helps to:

Protect your body from infections, control your pain, prevent damage to your bones, nerves, and other organs, like the kidneys, and boost your energy level.

The treatment plan for multiple myeloma is a group of different medicines called DRVD.

DRVD stands for: Daratumumab-Hyaluronidase, also called Daratumumbab, Revlimid,  - Velcade, and Dexamethasone.

DRVD is a targeted treatment that attacks specific parts of the cancer cells.

It is also an immunotherapy that helps your immune system fight and kill the cancer cells.

The first medicine of DRVD is Daratumumab.

This is a monoclonal antibody. It is a medicine that helps your immune system find and destroy cancer cells.

To do this, it recognizes a marker on myeloma cells called CD38.

Your care team will give you Daratumumab as a subcutaneous injection in the fatty part of your abdomen.

A subcutaneous injection is a shot you get under your skin.

The injection takes about 3 to 5 minutes.

Your care team will inject Daratumumbab into a different spot, or injection site, with every dose.

They'll watch you for one hour after the first injection to see if you have any reaction.

Your care team will give you a treatment calendar each cycle.

During Cycles 1 and 2, you'll get Daratumumab every week for 8 doses.

During Cycles 3 through 6, you'll get Daratumumab every 2 weeks for 8 doses.

After cycle 6, you'll get Daratumumab every 4 weeks.

The total length of treatment will depend on your treatment plan.

About 30 to 45 minutes before the first two daratumumab injections, you'll get pre-medication to help prevent any allergic reactions.

Your care team will give you: Acetaminophen (such as Tylenol), Diphenhydramine (such as Benadryl), Montelukast (such as Singulair),and a Steroid (Dexamethasone).

You may have allergic reactions, especially after your first dose of Daratumumab.

These include: Flushing, Cough,Rash, Dizziness ,Runny nose, and Shortness of breath

Other side effects include Irritation, swelling, itching, redness or pain where this drug is injected, Herpes zoster, also called shingles, Lower blood counts that can affect red blood cells, white blood cells, or platelets, Upper respiratory infections, Fatigue,

and diarrhea.

The 2nd medicine of DRVD is Revlimid. Revlimid is an oral capsule that you take by mouth at home.

Take the capsule in the evening or at bedtime, at the same time each day.

Take it with a full glass of water, with or without food.

Make sure to swallow the whole pill.

Do not chew, break, crush or open it.

A specialty pharmacy will deliver Revlimid to you. You must call 5 days before the next cycle to set up delivery.

Your care team will give you a treatment calendar each cycle.

You'll take 1 oral capsule for 21 days, then take 7 days off for each cycle.

Side effects from Revlimid include Blood clots, Lower blood counts that can affect red blood cells, white blood cells, or platelets, Diarrhea or constipation, Itching or skin rash, Fatigue, and muscle cramps.

Your care team will enroll you in the Lenalidomide REMS program. REMS stands for risk evaluation and mitigation strategies.

REMS is a drug safety program required by U.S. Food and Drug Administration (or FDA), for certain medicines that have safety concerns.

You'll need to take the Celgene Patient Survey to get the medicine.

The 3rd Medicine in DRVD is Bortezomib, also called Velcade, which is the V in DRVD.

Bortezomib is given as a subcutaneous shot in the fatty part of the abdomen.

Your care team will inject Bortezomib into a different injection site with every dose.

Your care team will provide you with a treatment calendar each cycle

You'll get a Bortezomib injection every week for 3 doses, then take 1 week off.

The total length of treatment will depend on your treatment plan.

Side effects of Bortezomib include Irritation or redness at the injection site, Shingles, Nerve problems like numbness, tingling, pain, or a burning feeling in the feet or hands, Lower blood counts that can affect red blood cells, white blood cells, or platelets, Fatigue, Nausea, and diarrhea or constipation

The 4th Medicine in DRVD is Dexamethasone. Dexamethazone is an oral steroid that helps the other medicines kill the cancer cells.

It is not a chemo drug.

You'll take Demethasone pills each treatment day. Take it with food to prevent an upset stomach.

Side effects of Dexamethasone include Upset stomach, Trouble sleeping, Restlessness (or feeling like you can't relax or get comfortable), Weight gain, Increased appetite, Indigestion, High blood pressure, and high blood sugar.

During your DRVD treatment, you'll also take other medicines to prevent side effects, including

Acyclovir to prevent shingles while you're on treatment.

Omeprazole to prevent upset stomach or indigestion while on treatment.

And Aspirin to prevent blood clots while on treatment.

Your care team will tell you what dose to take and when to take it.

If you have a history of hepatits B, you’ll also get 0.5 mg of Entecavir to prevent the Hepatitis B virus from reactivating, or multiplying in your body. Take 1 pill by mouth every day.

Before starting DRVD treatment, tell your care team if you have, or have ever had any of the following: Blood clots or shingles, Any allergies or changes in allergies, Tingling, numbness, or feelings of pins and needles in your hands or feet 

You should also tell them if you're taking any diabetes or weight loss medication, such as GLP-1,or any supplements or herbal medicines.

If you’re pregnant or trying to get pregnant, tell your care team.

While you're on DRVD Treatment, you'll have blood tests to monitor your counts before every treatment.

Your care team will check Myeloma markers once per cycle to see how you're responding to treatment.

If you need a blood transfusion during your DRVD treatment cycle, tell the healthcare provider that you're on daratumumab. This medicine can affect blood typing tests.

Some people may become neutropenic. This is when your white blood cell count is low.

If you do, your care team might give you an injection of filgrastim (also called Neupogen®). This helps your body make more white blood cells to help fight infections.

Call your care team right away if you notice signs of infection or allergic reaction

Signs of infection include: A fever of 100.4 °F (38 °C) or higher, Chills, Sore throat, or cough. Signs of an allergic reaction include A rash, Hives, Coughing, Wheezing, Shortness of breath, or trouble breathing, Don't wait to call your healthcare provider if you have any of these symptoms.

You should also call right away if you: Notice pain or burning while urinating, Have unusual bleeding or bruising, Feel dizzy or lightheaded, Or if you have any new or worsening symptoms.

Tell your care team if another healthcare provider prescribes any new medicines or antibiotics.

Someone from your care team is on call 24 hours a day.

You can also visit msk.org/pe to search for educational resources, videos, and online programs.