What Are High-Dose Steroids?

High-dose steroids are medicines that kill B cells in your body. B cells are white blood cells that usually protect you against infections. B cells change and turn cancerous if you have chronic lymphocytic leukemia (CLL).

Corticosteroids, or “steroids” for short, are sometimes used for CLL. 

Though steroids have an effect on B cells, they don’t directly target a specific protein that’s involved in B-cell growth. That’s why they are considered “untargeted” drugs.

How Do High-Dose Steroids Work?

Steroids help lower inflammation (swelling) in your body and calm down parts of your immune system. 

Specifically, these medicines hinder inflammatory chemical messengers called cytokines. They also help put the brakes on parts of your immune system that respond to cancer and other problems.

Steroids have a broad effect, which means they don’t specifically target B cells themselves. Other drugs focus on proteins that help B cells grow.

Ways Steroids Can Help With CLL infographic

Which High-Dose Steroids Are Used to Treat CLL?

When Are High-Dose Steroids Prescribed for CLL?

Doctors may prescribe steroids to help your body fight the cancer itself. Or they can be used to improve treatment side effects and other problems linked to your CLL. 

For instance, you may take a steroid to help lessen reactions of other cancer drugs, like:

  • Chemotherapy (chemo)
  • Medicines known as monoclonal antibodies, such as rituximab (Rituxan)
  • Newer targeted therapies, such as ibrutinib (Imbruvica)

And steroids can shrink swollen lymph nodes. They may also treat serious CLL complications, like:

  • Autoimmune hemolytic anemia (AIHA): Your body’s immune system destroys your red blood cells.
  • Immune thrombocytopenic purpura (ITP): Your body’s immune system mistakenly attacks the platelets in your blood.

Doctors often prescribe steroids along with other cancer medicines. When used in this way, they may make the treatment more able to fight cancer. Steroids are commonly combined with the drugs rituximab and obinutuzumab (Gazyva).   

How Do You Take High-Dose Steroids?

They can be given via a pill or shot. Typically, steroids for CLL are given by mouth at higher doses than they are given for other uses. 

Your dose schedule may vary. In some studies, starting steroid doses for CLL looked something like this:

  • Dexamethasone: 40 milligrams (mg) on days one through four and days 10 through 13 (of a three-week cycle)
  • Methylprednisolone: 1 gram daily for five days

How Effective Are High-Dose Steroids?

There’s not a whole lot of research on how well high-dose steroids work for CLL. With that in mind, some studies that have looked at these medicines found:

Are High-Dose Steroids Safe?

Safety is a concern when it comes to corticosteroids. 

In high doses, steroids can cause serious or life-threatening infections in people with CLL. That’s because the drugs put a halt on your immune system. This makes it easier for you to catch an infection and harder to fight one off. 

Other possible serious problems that can happen due to steroid use include:

  • A severe allergic reaction
  • Cushing syndrome (a condition that happens when your body is exposed to too much of the stress hormone cortisol) 
  • Issues with your adrenal glands (small glands that sit on top of your kidneys)
  • Muscle damage
  • Psychosis
  • Brain swelling or seizures
  • Diabetes
  • Low levels of potassium
  • High blood pressure
  • Heart failure
  • Peptic ulcers (sores that form on the lining of your stomach or small intestines)
  • Holes or bleeding in your intestines 
  • Swelling of your pancreas
  • Bulging eyes
  • Ruptured tendons
  • Osteonecrosis (a condition that happens when bone tissue dies because of a lack of blood flow)

And long-term steroid use can lead to these medical issues:

  • Eye problems, like cataracts or glaucoma
  • Growth issues in children
  • A weakened immune system 
  • Kaposi sarcoma (a rare form of skin cancer)
  • Withdrawal symptoms if you stop the medicine suddenly 

Because of these serious risks, many doctors suggest that if you use steroids, you take the lowest dose for the shortest amount of time possible. 

What Are Common Side Effects of High-Dose Steroids?

The most common side effects of high-dose steroids are:

  • High blood pressure
  • Edema (your body holds too much water and you have swelling)
  • Nausea, vomiting, or upset stomach
  • Muscle loss
  • Skin changes, like skin thinning or redness
  • Easy bruising
  • Slow wound healing
  • Acne
  • Unusual hair growth
  • Anxiety, depression, or mood swings
  • Trouble sleeping
  • Weight gain or hunger

Ways to manage side effects 

To help deal with the side effects of steroids, you may want to:

Watch your weight. Steroids can cause weight gain. Try to eat a healthy diet that includes plenty of fruits and vegetables. Also, exercise regularly to control your weight.

Keep bones healthy. Eat foods with lots of calcium and vitamin D to protect yourself from osteoporosis. Ask your doctor if you should take specific supplements for bone health. Also, avoid smoking, and if you drink alcohol, do it only in moderation.

Protect your eyes. Schedule regular eye exams, so you can catch eye problems like cataracts or glaucoma early. 

Practice infection protection. To lower your risk of an infection, wash your hands often, stay away from sick people, and keep any cuts or wounds clean. Tell your doctor if you have any signs of infection, like a high fever.

Who Should Not Take High-Dose Steroids?

These medicines aren’t a good fit for everyone with CLL. Your doctor can help you decide if steroids could be a safe and effective treatment for your cancer. You should tell your provider if you have had:

  • An active infection or wounds that aren’t healed
  • Recent contact with someone who has chickenpox, measles, or shingles
  • Liver or kidney problems
  • Mental health issues
  • Tuberculosis (TB)
  • An allergic reaction to steroids or other medicines
  • Heart issues, like high blood pressure, heart failure, or a recent heart attack
  • Epilepsy
  • Diabetes
  • Underactive thyroid
  • Glaucoma
  • Osteoporosis (thinning bones)
  • Stomach ulcers
  • Myasthenia gravis (a condition that causes muscle weakness)
  • Recent vaccinations

How Much Do High-Dose Steroids Cost?

The price of steroids varies. The amount you pay will depend on your dose, the pharmacy you use, and your insurance coverage.

Some online drug information sites estimate these costs:

  • Without insurance, the retail cost of a 21-tablet pack of methylprednisolone 4 mg runs around $18.68.
  • At most pharmacies, the average retail cost of dexamethasone 4 mg is $27.72 for a 10-tablet pack.

These prices are relatively inexpensive compared to the cost of other drugs. But you may also take other pricey medications. For instance, rituximab (Rituxan), which is often taken with steroids, can cost hundreds of dollars, depending on the pharmacy you visit. This price doesn’t take insurance into account.

Pharmacy coupons can help lower the cost of drugs. Also, some nonprofit organizations may offer financial assistance. Here are some possible resources:

Clinical Trials of High-Dose Steroids for CLL

Clinical trials are medical studies that help researchers find out if certain treatments are safe and effective. 

New types of steroids are currently being tested in clinical trials. Researchers want to identify drugs that work well but don’t cause severe side effects. 

If you’re interested in a clinical trial for CLL, talk to your doctor. These websites also offer information about different types of studies:

What to Know if You’re a Caregiver 

Caring for someone with CLL can take a toll on your mental health. If they take high-dose steroids, you might worry about the possible risks or side effects of the medicine.

Here are some ways to help both you and the person you care for:

  • Help your loved one with meals, chores, and transportation.
  • Provide emotional support for the person with CLL.
  • Go to doctor’s appointments with the patient.
  • Keep track of your loved one’s side effects and report them to their medical team.
  • Help the patient stay on their medication schedule.
  • Make sure you take good care of yourself.
  • Get enough rest, and take breaks when you need them.

Are High-Dose Steroids for CLL Right for Me?

Your medical team can help you decide whether steroids are a good option for your CLL. Here are some things to consider:

symptoms 1 graphic

Your overall health. Doctors may assess whether you are healthy enough, and infection-free, before they give you a steroid.

symptoms 2 graphic

Side effects. Steroids can cause severe side effects. Think about all the possible risks and benefits before you take these medicines.

syringe 3 infographic

Your previous treatments. Your past CLL treatments may determine whether your doctor puts you on a steroid.

stethoscope calendar graphic

Length of treatment. Most of the time, it’s best to take steroids at the lowest dose, for the least amount of time possible. 

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Alternatives. Ask your doctor if there are other medicines that may work better and pose fewer risks.

Show Sources

SOURCES:

Leukaemia Foundation: “Chronic lymphocytic leukaemia (CLL).”

CLL Society: “Steroids in Chronic Lymphocytic Leukemia (Part 1),” Immune Thrombocytopenic Purpura (ITP),” “Steroids: The Downside (Part 2).”

Leukemia & Lymphoma Society: “Chemotherapy and Drug Therapy,” “Caregiver Support.”

Blood: “Molecular Mechanism of Action of Glucocorticoids in Lymphoma Therapy.”

Endocrinology: “Analysis of Glucocorticoid Receptors and Their Apoptotic Response to Dexamethasone in Male Murine B Cells During Development.”

Cell Reports: “miR-29 Sustains B Cell Survival and Controls Terminal Differentiation via Regulation of PI3K Signaling.”

Cancer Research UK: “Supportive treatments for chronic lymphocytic leukaemia (CLL).”

Cleveland Clinic: “Autoimmune Hemolytic Anemia,” “Immune Thrombocytopenia.”

Advances in Medical Sciences: “Efficacy of high-dose corticosteroid-based treatment for chronic lymphocytic leukemia patients with p53 abnormalities in the era of B-cell receptor inhibitors.”

Blood: “Rituximab and High-Dose Dexamethasone (R-dex) Is Effective In The Treatment Of Relapsed/Refractory Chronic Lymphocytic Leukemia.”

Cancer Medicine: “Chronic lymphocytic leukaemia/small lymphocytic lymphoma treatment with rituximab and high-dose methylprednisolone, revisited.”

Haematologica: “Treatment of autoimmune hemolytic anemias.”

Expert Opinion on Investigational Drugs: “The role of high-dose corticosteroids in the treatment of chronic lymphocytic leukemia.”

Mediterranean Journal of Hematology and Infectious Diseases: “Infectious Complications in Chronic Lymphocytic Leukemia.”

Lupus Foundation of America: “Managing side effects of steroids.”

National Health Service (U.K.): “Who can and cannot take dexamethasone tablets and liquid,” “Who can and cannot take prednisolone tablets and liquid.”

Frontiers in Immunology: “Immunomodulation – a general review of the current state-of-the-art and new therapeutic strategies for targeting the immune system.”

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