Lower doses of common steroid shows ‘no differences’ in treating newly diagnosed myeloma, says new national study
HonorHealth Research Institute investigators urge lowering doses of dexamethasone in treatment of this blood cancer
SCOTTSDALE, Ariz. — Jan. 14, 2025 — Dexamethasone, a steroid commonly used in the treatment of myeloma, a blood cancer, could be given to patients at a lower dose than in historic treatments with no loss of effect, according to a new study and an editorial by HonorHealth Research Institute investigators published this month in the journal Blood.
In the past, effective doses of dexamethasone were as high as 40 mg, 4 days a week. Contemporary treatment regimens have shown that 40 mg just once a week is just as effective, and with less toxicity.
In a national study of 541 patients titled “Dexamethasone dose intensity does not impact outcomes in newly diagnosed multiple myeloma: a secondary SWOG analysis,” researchers concluded that “there were no differences” in outcome between patients who received 40 mg to 60 mg weekly versus those who required dose reductions and even discontinuation of dexamethasone. This evidence suggests that dosing below 40 mg weekly does not decrease efficacy, but does produce major benefits for quality of life.
“Given the many toxicities and unclear benefits of dexamethasone in the era of modern treatment regimens, dexamethasone dose reduction during (newly diagnosed multiple myeloma) NDMM induction warrants further prospective studies,” the paper concluded. Importantly, the paper said, patients receiving lower doses were “associated with lower mortality than higher doses.”
In an accompanying editorial in Blood, investigators at HonorHealth Research Institute concluded, “dexamethasone-sparing strategies can reduce steroid-induced toxicity and allow for patients to continue long-term myeloma treatment with improved quality of life.”
Susan Harding, a Nurse Practitioner at HonorHealth Research Institute who specializes in Hematology and Oncology — and one of the authors of the editorial, “Down with Dex!” — said, “Although the exact dosing and role of dexamethasone in contemporary treatment of multiple myeloma needs clearer definition, this study suggests that further reduction of this agent and its toxicity are possible. It is time to go down with dex!”
Steroids, used alone and in combination with other drugs, have played an important role in the treatment of myeloma, and dexamethasone is the most commonly prescribed corticosteroid for this cancer.
However, steroids cause a wide range of side effects, affecting nearly every system of the body, including: insomnia, sexual dysfunction, personality changes and mood swings, hyperactivity, dizziness, headaches, difficulty concentrating, weakened muscles and bones, weight gain and blurred vision.
“Minimizing these side effects and managing them quickly can help contribute to the successful treatment of myeloma,” said the other author of the editorial, Joseph Mikhael, M.D., director of Myeloma Research and Consultant Hematologist at HonorHealth Research Institute, and Chief Medical Officer for the International Myeloma Foundation. He also is a Professor at the Translational Genomics Research Institute.
# # #
About the HonorHealth Research Institute
HonorHealth Research Institute is an international destination that is at the forefront of providing patients with a better quality of life through its clinical trials and innovative treatment options. Headquartered in Scottsdale, Arizona, the institute’s team of physicians and researchers collaborate with experts from across the nation to offer life-changing therapies, drugs and devices. At HonorHealth Research Institute, patients have access to tomorrow’s health innovations, today. Learn more at: HonorHealth.com/research.
