Bortezomib + Rituximab + Dexamethasone (BDR) × 6-8 cycles — chemo-free alternative for r/r WM (incl CXCR4-WHIM-mutated)

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-RITUXIMAB` `DRUG-DEXAMETHASONE`

ID	`REG-VRD-WM`
Type	Regimen
Status	reviewed 2026-04-25 \| pending_clinical_signoff
Diseases	None declared
Sources	`SRC-ESMO-WM-2024` `SRC-NCCN-BCELL-2025`

Notes

CXCR4-WHIM-mutated WM (~30%) has reduced depth of response to BTKi (zanubrutinib + ibrutinib both) — proteasome inhibitor mechanism (bortezomib) bypasses BTK pathway dependence. BDR per Treon 2009 showed major response rate ~88% in r/r WM. Weekly subcutaneous bortezomib substantially reduces peripheral neuropathy vs twice-weekly IV. Time-limited (~6-8 cycles) — distinct from continuous BTKi paradigm. UA practical advantage: all components reimbursed.

Used By

Indication

IND-WM-2L-VRD - IND-WM-2L-VRD