Corticosteroids – or steroids – are a key part of treatment for multiple myeloma (MM). They can help other drugs fight cancer cells and ease swelling. Smaller amounts can be combined with injection therapies to stave off allergic reactions and stop nausea and vomiting. Sometimes steroids alone are used to treat MM, too.
What Are Corticosteroids?
They’re not the hormone-like drugs some athletes use to bulk up. They’re a synthetic or lab-made version of cortisol, a hormone made in your adrenal glands. While natural cortisol mainly helps your body manage stress, corticosteroids are added to your body’s natural stores to control inflammation and other symptoms MM causes.
A common corticosteroid used for MM is dexamethasone, also known as “dex.” You can take it as a tablet or as an injection. It can do many things:
- Ease inflammation from around tumors.
- Curb pain by lowering the swelling around tumors and keeping them from pressing as much on nearby nerves.
- Stop white blood cells from going to swollen areas of your body. In general, white blood cells fight infection and substances like bacteria. If you have MM, your immune system doesn’t work correctly. The swelling can cause damage. Steroids suppress this.
- Offset side effects from MM and your treatment meds, such as nausea and vomiting from chemo.
Are Corticosteroids All the Same?
Though dexamethasone is one of the most prescribed meds for MM, others in the same class of adrenal corticosteroids work the same way. They have the same side effects, and they fight MM and control swelling just as well. They include prednisone, prednisolone, and methylprednisolone.
Even so, some people might tolerate one steroid type better than another.
When Do You Use Steroids With MM?
Steroids are used at every stage. More than one drug is usually used to treat MM at any point. Your doctor has many combos to choose from. They’ll decide carefully, as current meds don’t usually cure MM. Your doctor might prescribe meds based on a long-term plan. Most people will have many different treatments while they have the disease.
Induction therapy. If you have MM symptoms, this is the first treatment phase you’ll have. Induction therapy uses a combo of two or three drugs. Steroids often will be one. Others might include chemo and targeted therapy meds, which go after proteins and genes in cancer cells, but aren’t as harsh as chemo.
Induction therapy aims to cut the number of plasma – myeloma – cells in your bone marrow, as well as proteins they make. This treatment phase usually lasts for a few months.
Your therapy after this will likely continue to include a steroid, whether you're having a stem cell transplant or not.
Relapsed or refractory multiple myeloma. Almost everyone with MM has a relapse. It means although your treatment has improved your condition for a while, symptoms and signs of the disease have come back. Refractory MM happens when the initial therapy doesn’t work, or at least doesn’t work very well. It can happen during your first chemo or during chemo after a relapse.
Refractory MM is harder to treat. Still, both relapsed and refractory MM are treated with combos of two or three meds from different classes. Dex often is in the mix, along with immunomodulatory drugs, proteasome inhibitors, monoclonal antibodies, or chemo. Your doctor might arrange different combos over time. Most people will get each kind of drug at some point.
Common Side Effects
Like any drug, steroids bring side effects. A few are:
- Heartier appetite and weight gain
- Sleep problems
- Mood changes
- High blood sugar
Most side effects go away after the drug is stopped.
Risks of Long-Term Use
Effects of medications can change over time and as you age. For example, long-term steroid use can over-suppress your immune system. This can open the door for major infections. Steroids can also weaken your bones. A condition called osteoporosis, meaning loss of bone density, can lead to fractures.
Steroids can affect your bones in two main ways: They can hamper how your body absorbs calcium, a mineral that keeps your bones strong, and they can speed up how fast your bones break down. The more and longer you take steroids, the more likely you’ll be to get osteoporosis.
There’s good news, though. Italian researchers studied older people whose steroid use was getting risky. They found that a standard treatment combo of a commonly used cancer drug called lenalidomide (Revlimid) and dex wasn’t necessary. Decreasing the lenalidomide dosage and dropping the dex altogether had much the same outcome as using both.
The change allows people to safely and effectively stay on treatment for longer, and control their MM without steroids.
Doctors try to identify people at high risk for osteoporosis before starting them on steroids. They’ll likely use the lowest dose possible for as short a time as possible, or sub in another type of drug. Medicines called biphosphonates are often used to combat the bone thinning that steroids can cause.