There was a case study published last month that I thought people here in the forum might want to know about.
It was written by researchers at Roswell Park Cancer Center, and concerns a multiple myeloma patient who had a very deep response to treatment with high-dose prednisone after failing to achieve more than a partial response to several other treatment regimens.
I mention the case study mainly so that people are aware of this treatment option. It could be a useful option to try, potentially as a bridge to another therapy, if other treatments don't seem to be working.
In this particular case, the patient seems first to have been diagnosed with smoldering multiple myeloma. However, her disease progressed within about a year to symptomatic multiple myeloma. She then began treatment with cyclophosphamide, Velcade, and dexamethasone (CyBorD).
She only got a partial response from CyBorD, and the response did not deepen when she was treated with the "D-PACE" and then "VD-PACE" regimens. A stem cell transplant also did not seem to deepen the response very much, and her disease was progressing noticeably within a year of starting CyBorD.
At that point, her doctors chose to put her on high-dose (2 grams) of intravenous methylprednisolone, a form of prednisone, given 3 times weekly. The dosing frequency eventually was dropped to once weekly after about 2 months of the 3 times weekly dosing.
Here's the impressive result: After about 8 months of treatment with just the high-dose prednisone, the woman achieved a complete response. She was then transitioned to maintenance therapy with Revlimid and dexamethasone.
Now, this is just a single patient's case, and high-dose prednisone doesn't always work. But, as I mentioned earlier, it may be something people want to keep in mind.
Here is the reference for the journal article with the case study:
K Celotto et al, "Remarkable Response to Methylprednisolone in a Multiple Myeloma Patient with Nodal Disease Refractory to High-Dose Chemotherapy," Cureus, Dec 16, 2015 (full text of article)
Here is the abstract:
Multiple myeloma is a disorder of malignant plasma cells, which is characterized by paraprotein production, lytic bone lesions, hypercalcemia, susceptibility to infections, and renal impairment. Here, we describe a patient with IgA myeloma with extensive nodal involvement who obtained significant benefit from high-dose methylprednisolone after failing aggressive induction chemotherapy and high-dose melphalan with autologous stem cell support.
The authors of this case study chose to give the patient the high-dose prednisone therapy because they recalled this study from 1995 that reported results of a Phase 2 trial testing high-dose prednisone:
MA Gertz et al, "A phase II study of high-dose methylprednisolone in refractory or relapsed multiple myeloma", Leukemia, Dec 1995 (abstract at PubMed).
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Re: Case study: high-dose prednisone
Thanks, Cheryl. That is indeed a very interesting case and a very interesting journal article.
Re: Case study: high-dose prednisone
Prednisone is an interesting option. I have often wondered why it is not used more as an alternative to dex. Everyone hates the dex. At one point, I used low-dose prednisone as an alternative and had none of the dex side effects.
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goldmine848 - Name: Andrew
- When were you/they diagnosed?: June 2013
- Age at diagnosis: 60
Re: Case study: high-dose prednisone
As a coincidence, I started prednisone last week. I'm doing Revlimid, Velcade, and dexamethasone (RVD) induction in cycle 3 and broke out in a rash, which was traced to the 25 mg daily Revlimid. So my oncologist prescribed prednisone 20 mg a day and lowered the Revlimid to 10 mg a day. The prednisone was prescribe to prevent another reaction, not as a "treatment," but after reading that article, maybe the prednisone is wearing more than one hat.
Re: Case study: high-dose prednisone
Thanks for the comments everyone.
A couple of things are worth pointing out as follow ups to what I wrote earlier.
One is that the study involved methylprednisolone, not prednisone. Methylprednisolone is a variant of prednisolone, which is what the body turns prednisone into when it metabolizes prednisone.
The more medically trained among the forum members can say whether this makes a big difference. My impression is that these different variations of prednisone are all viewed as very similar when used in myeloma patients. The one difference is that 1 mg of methylprednisolone has the same potency as about 1.25 mg of prednisone. In other words, milligram for milligram, methylprednisolone is more potent than prednisone.
The other thing I would emphasize is that this study is about HIGH-DOSE methylprednisolone – 2000 mg of methylprednisolone (equal to 2500 mg of prednisone) given three times a week, and then tapered down to once a week. That is A LOT more than the kind of doses myeloma patients usually get when they're given prednisone.
I'm not saying that lower dose prednisone isn't effective. There are plenty of studies that show that it helps, particularly in combination therapy, such as with Velcade and melphalan. But the doses used in those regimens are much lower, on the order of 100 mg per day for four days every 28-day cycle, compared to the high-dose regimen discussed in this article.
A couple of things are worth pointing out as follow ups to what I wrote earlier.
One is that the study involved methylprednisolone, not prednisone. Methylprednisolone is a variant of prednisolone, which is what the body turns prednisone into when it metabolizes prednisone.
The more medically trained among the forum members can say whether this makes a big difference. My impression is that these different variations of prednisone are all viewed as very similar when used in myeloma patients. The one difference is that 1 mg of methylprednisolone has the same potency as about 1.25 mg of prednisone. In other words, milligram for milligram, methylprednisolone is more potent than prednisone.
The other thing I would emphasize is that this study is about HIGH-DOSE methylprednisolone – 2000 mg of methylprednisolone (equal to 2500 mg of prednisone) given three times a week, and then tapered down to once a week. That is A LOT more than the kind of doses myeloma patients usually get when they're given prednisone.
I'm not saying that lower dose prednisone isn't effective. There are plenty of studies that show that it helps, particularly in combination therapy, such as with Velcade and melphalan. But the doses used in those regimens are much lower, on the order of 100 mg per day for four days every 28-day cycle, compared to the high-dose regimen discussed in this article.
Re: Case study: high-dose prednisone
This treatment harkens back to the day when steroids were the only treatment available for people with myeloma. It's important that even with all of the new drugs that the older ones still remain in people's minds as possibilities when nothing else is working.
Nancy in Phila
Nancy in Phila
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NStewart - Name: Nancy Stewart
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 3/08
- Age at diagnosis: 60
Re: Case study: high-dose prednisone
I agree with you, Nancy. I am just starting this journey, but I am keeping all this in mind just in case someday my dear husband gets to that point when we are looking for our next trick to pull out of the treatment bag. 
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dogmom - Who do you know with myeloma?: husband
- When were you/they diagnosed?: December 2015
- Age at diagnosis: 58
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