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This is a combination therapy regimen consisting of three active pharmaceutical ingredients: bendamustine, bortezomib, and dexamethasone. Bendamustine is a bifunctional alkylating agent that induces DNA cross-linking and strand breaks, leading to cell cycle arrest and apoptosis. Bortezomib is a reversible inhibitor of the 26S proteasome, which disrupts the degradation of pro-apoptotic proteins and inhibits the NF-κB pathway, particularly effective in plasma cell malignancies. Dexamethasone is a potent synthetic glucocorticoid that provides anti-inflammatory effects and synergizes with chemotherapy by inducing apoptosis in lymphoid cells. This specific combination, often abbreviated as BVD, was investigated by the Intergroupe Francophone du Myelome (IFM) in the Phase II trial IFM 2009-01 (NCT01045681) as a second-line treatment for elderly or transplant-ineligible patients with relapsed or refractory multiple myeloma.
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