VRd-lite (Bortezomib + Lenalidomide + Dexamethasone, attenuated for elderly/frail MM)

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

Knowledge-base record for audit. Provisional clinical content: this is not a prescription. An oncologist must verify original sources, applicability and review status. Full rules and constraints are in the YAML.

Source YAML: complete record

Components	`DRUG-BORTEZOMIB` `DRUG-LENALIDOMIDE` `DRUG-DEXAMETHASONE`

ID	`REG-VRD-LITE`
Type	Regimen
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	None declared
Sources	`SRC-ESMO-MM-2023` `SRC-NCCN-MM-2025`

Notes

O'Donnell et al. (Br J Haematol 2018) — VRd-lite phase II in transplant-ineligible MM (median age 73): ORR ~86%, ≥VGPR ~66%, median PFS 35 mo, with substantially less toxicity than full-dose VRd. Weekly bortezomib SC + reduced lenalidomide (15 mg vs 25 mg) + weekly dexamethasone (20 mg vs 40 mg). 35-day cycle (vs 21-day full VRd) gives recovery time. Reasonable alternative to D-Rd (MAIA) when daratumumab not accessible. Frailty-adapted dosing per IMWG.

Used By

Handbook Chapters

HB-MM-1L - Multiple myeloma: first-line risk and fitness reasoning

Indication

IND-MM-ELDERLY-FRAIL-VRD-LIGHT - IND-MM-ELDERLY-FRAIL-VRD-LIGHT

Regimen

REG-D-RD-MAIA - Daratumumab + Lenalidomide + Dexamethasone (D-Rd, MAIA — MM 1L transplant-ineligible)