Corticosteroids for multiple myeloma

Corticosteroids are a class of potent anti-inflammatory medications that play a central role in treating the rare blood cancer multiple myeloma.

Not only can corticosteroids work directly to kill cancerous myeloma cells, but they also help prevent side effects associated with other myeloma treatments.

Most people with myeloma receive corticosteroids. They are included in treatment regimens across all stages of the disease, including in newly diagnosed patients, after a stem cell transplant, and in those whose cancer has returned (relapsed) or failed to respond (refractory) to initial treatment.

What are corticosteroids?

Corticosteroid medications are lab-made compounds designed to mimic the effects of cortisol, a naturally occurring hormone. Often called the body’s main stress hormone, cortisol has powerful anti-inflammatory and immune-suppressing effects.

In many cancers, corticosteroids are used to relieve inflammation, swelling, and pressure that’s caused by tumors. They also help prevent and manage treatment-related side effects such as nausea and pain.

Their role in blood cancers like myeloma is unique. In addition to managing side effects and symptoms, corticosteroids can also directly contribute to the death of cancerous cells. This is because blood cancers arise from immune cells, which are naturally sensitive to the effects of steroids like cortisol. As a result, corticosteroids can:

enter myeloma cells and trigger cell death by disrupting survival pathways
alter the environment around cancer cells, limiting signals needed for growth
make cells more vulnerable to other myeloma treatments

How corticosteroids are used in multiple myeloma

Corticosteroids are used at all stages of myeloma treatment. One of the most commonly used steroids is dexamethasone, although others, such as prednisone or methylprednisolone, may be used in certain situations.

The specific steroid regimen depends on whether steroids are being administered as part of the effort to slow myeloma growth or to manage side effects of other treatments.

Treating myeloma

When used to treat myeloma, corticosteroids are typically included in combination regimens with other classes of treatments. Dexamethasone is included in nearly all myeloma regimens, including those for newly diagnosed patients and people with relapsed or refractory disease.

In most regimens, dexamethasone is taken orally once a week at a relatively high dose and may be continued for several months. Increasingly, experts recommend tapering or stopping corticosteroids once the disease is stable to reduce the risk of serious side effects.

Some older myeloma regimens use prednisone. This medication may be a gentler option for older or frail patients who cannot tolerate the side effects of stronger steroids. Prednisone is less potent and shorter-acting than dexamethasone and may be taken once daily on certain days of each treatment cycle.

Managing myeloma treatment side effects

Corticosteroids are also commonly used to manage side effects of other myeloma treatments. In this setting, they are usually given at lower doses for shorter periods, often just before and/or after other medications.

Specifically, they may be:

taken orally or given by infusion before antibody therapies to prevent immune reactions
taken orally for a few days after treatment to prevent delayed allergic reactions, nausea, or vomiting

Dexamethasone is the most commonly used medication for managing side effects. If an immune reaction to another medication occurs, methylprednisolone or dexamethasone may be infused into the bloodstream as a rescue medication to control the reaction.

Side effects

Corticosteroids are powerful medications that can cause a wide range of possible side effects, including:

sleep problems
changes in mood, such as irritability
high blood sugar
acne and other skin changes
increased appetite and weight gain

Long-term use of corticosteroids can lead to serious side effects, including weakened bones and suppression of the immune system, which increases the risk of serious infections. For this reason, doctors usually try to taper the use of these treatments when myeloma is stable or in remission.

Most side effects of corticosteroids go away after the medication is stopped. Patients should talk with their care team about what to expect with their specific treatment plan.

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