I always use VRd once a week, and almost never ever use VRd twice a week. Velcade twice a week is how it was studied in the trial, but there is a wealth of data (again- not prospective or robust) that indicates Velcade once a week is as effective and a LOT less toxic much lower incidence of neuropathy. Whether you do 21 day cycles (Len two weeks on/1 week off) or 28 day cycles (Len three weeks on/1 week off) is acceptable, but Velcade in my opinion should be given just once a week.