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Steroids in Chronic Lymphocytic Leukemia (Part 1)

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This is the first of a three-part series on the use of steroids in chronic lymphocytic leukemia (CLL).

In this part, steroids will be explained and the multiple roles of steroids in CLL will be reviewed.

The second part will review the side effects of steroids.

The final part will examine the methodology shortcomings described in a recent article published in the British Journal of Medicine (Short term use of oral corticosteroids and related harms among adults in the United States: population based cohort study) on the dangers of short-term steroid use.

Finally. I will offer my bottom line on this potent class of drugs.

What are Steroids?

What we are talking about in this series of articles is one particular class of steroids that is produced in the cortex of the adrenal gland, hence known as corticosteroids, but usually just called steroids for short.

Our healthy body makes these steroids every day and they are critical for our well-being and survival. They are involved in our stress response, our immune response, and regulation of metabolism and electrolyte balance.

However, when steroids are manufactured and given as a drug, usually in higher and sometimes in much higher “pharmacologic” doses than the body naturally produces (physiological doses), their effects are profound.

They are powerful and broadly active anti-inflammatories and immune-suppressors. They inhibit multiple inflammatory cytokines (chemical messengers) and suppress most components of the body’s immune response to challenges, such as infections, allergies and cancers.

The use of steroids is truly one of the triumphs of modern medicine and has revolutionized care.

They have been helping patients since the late 1940s with unrivaled symptomatic relief for a wide range of conditions, including many forms of arthritis, sciatica, asthma and chronic lung diseases, MS (multiple sclerosis), some types of infections, several skin disorders and dermatitis, and many other allergic and autoimmune conditions.

They are commonly used in emergency rooms and in hospital wards with tremendous effectiveness for the life-saving support of severe allergic reactions, such as anaphylaxis, brain swelling from trauma or inflammation, and critically low blood pressure from infection and other causes.

And of course they are used for those with the rare problem of insufficiency of the adrenal glands, the body’s steroid factories, which is a condition known as Addison’s Disease where insufficient amounts of steroids are produced.

Steroids in CLL

In CLL, steroids have multiple possible uses.

Takeaway Points:

Steroid indications in CLL:

  • Mitigating our body’s potentially dangerous allergic reaction to monoclonal antibodies (mAbs) such as rituximab and others that may contain some foreign murine (rodent) proteins. Almost all mAB infusions are pre-medicated with some type of steroid.
  • Minimizing the toxicities of some IV and oral chemotherapy drugs.
  • Suppressing the serous autoimmune complications seen in CLL, such as AIHA (auto-immune hemolytic anemia) and ITP (immune thrombocytopenic purpura) and others.
  • Adjunctive (additive) therapy potentially boosting the cancer killing efficacy, as part of several drug cocktails
  • As a CLL killer when used in ultra high doses (HDMP or high dose methylprednisolone) in combination with mAbs.
  • Reducing some of the adverse effects associated with the newer targeted therapies, such as ibrutinib.
  • Short-term reduction of painfully swollen lymph nodes.
  • Rarely to boost energy, a sense of well-being and appetite

This list on the uses of steroids inside and out of CLL are not meant to be exhaustive, just illustrative of the wide swath they cut across the care of CLL and other conditions.

  • For very many of us with CLL, steroids make our treatments safer, more efficacious, and more tolerable.
  • For a few us, they offer deep and durable disease control without damaging the bone marrow.
  • For some of us, they are life-saving.
  • However, all these benefits come with a price.

The next installment will review the downside to steroids.

Brian Koffman, MD  4/25/17