Recently Diagnosed or Relapsed? Stop Looking For a Miracle Cure, and Use Evidence-Based Therapies To Enhance Your Treatment and Prolong Your Remission
Multiple Myeloma an incurable disease, but I have spent the last 25 years in remission using a blend of conventional oncology and evidence-based nutrition, supplementation, and lifestyle therapies from peer-reviewed studies that your oncologist probably hasn't told you about.
Click the orange button to the right to learn more about what you can start doing today.
Dexamethasone dose reductions did not impact PFS or OS. This is probably the most impactful sentence I have ever written. I say this because no myeloma therapy that I know of has caused more short, long-term or late stage side effects than dex. has. For the record, I cannot support this statement with research. I’m making this statement simply from my experience.
And the solution to the MM patient experiencing side effects from dex.? Either to lower the dose or to stop taking the drug altogether. And now, according to the research below, we now know that dose reductions are common and make no difference to the MM patient’s PFS (length of remission) or the patient’s OS (length of life).
So why does oncology prescribe dex?
Dexamethasone dose have benefits for the myeloma patient. The take-away from the research below is that the benefit from dex. can be obtained from lower doses. And lower doses mean less toxicity and fewer side effects. Simply put dexamethasone dose reductions did not impact PFS or OS.
What are the possible side effects of dexamethasone?
Common side effects:
Increased appetite and weight gain
Fluid retention (leading to swelling in the hands, feet, or face)
Insomnia or difficulty sleeping
Mood changes (such as anxiety, irritability, or euphoria)
Increased blood sugar levels (especially in people with diabetes)
Indigestion or stomach discomfort
Serious side effects:
Immune suppression, leading to a higher risk of infections
Osteoporosis or weakening of bones (especially with long-term use)
Muscle weakness
Stomach ulcers or gastrointestinal bleeding
High blood pressure (hypertension)
Eye problems, including cataracts or glaucoma
Adrenal suppression, where the body’s natural production of steroids decreases, potentially leading to adrenal crisis if stopped suddenly
Cushing’s syndrome, due to prolonged high doses (symptoms include fat deposits around the face, upper back, and abdomen, along with thinning skin and easy bruising)
Delayed wound healing
Psychiatric effects, such as mood swings, depression, or even psychosis
Rare but severe reactions:
Severe allergic reactions (rash, itching, swelling, difficulty breathing)
Blood clots or changes in blood clotting
Vision changes
I am a long-term survivor of multiple myeloma. I gained 50 lbs. during the six months I was on dex. My wife jokes about how dex. caused serious mood swings for me. I’m glad that my wife can joke about this now. Some patients on dex. experience serious mental illness.
If you would like to learn more about both conventional and non-conventional myeloma therapies email me at David.PeopleBeatingCancer@gmail.com
Dexamethasone dose reductions below 40-60 milligrams weekly are common in multiple myeloma, even for patients enrolled on clinical trials.
Dexamethasone dose reductions did not impact PFS or OS in newly diagnosed multiple myeloma in multivariate analyses.
Dexamethasone is a key component of induction for newly diagnosed multiple myeloma (NDMM) despite common toxicities including hyperglycemia and insomnia.In the randomized ECOG E4A03 trial, dexamethasone 40 milligrams (mg) once weekly was associated with lower mortality than higher doses of dexamethasone. However, the performance of dexamethasone dose reductions below this threshold with regard to progression-free survival (PFS) and overall survival (OS) in NDMM have not been fully characterized.We conducted a secondary pooled analysis of the S0777 and S1211 SWOG studies of NDMM, which employed lenalidomide-dexamethasone (Rd) alone with or without bortezomib (VRd) and with or without elotuzumab (Elo-VRd).Planned dexamethasone intensity was 40-60 mg weekly in all arms. Patients were categorized into FD-DEX (full-dose dexamethasone maintained throughout induction) or LD-DEX (lowered-dose dexamethasone or discontinuation; only permitted for Grade 3+ toxicities per both study protocols).Of 541 evaluated patients, the LD-DEX group comprised 373 patients (69%). There was no difference in PFS or OS between the FD-DEX or LD-DEX groups, which were balanced in terms of age, stage, and performance status.Predictors of PFS and OS in multivariate models were treatment arm, age ≥70, and thrombocytopenia; FD-DEX did not significantly improve either outcome. Our study suggests that dexamethasone dose reductions are common in multiple myeloma, even within clinical trials.Given dexamethasone’s many toxicities and unclear benefit in the era of modern treatment regimens, dexamethasone dose reduction during NDMM induction warrants further prospective study. NCT00644228, NCT01668719
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2 comments
Deborah Rogow says
a few months ago
I agree, David. Dexamethasone caused me to have spinal fractures, cataracts, and many nights of sleeplessness. By suppressing my adrenal hormone production, it also shut down my estrogen secretion — which caused significant changes in my appearance (hair, skin, body shape). I wish I had refused the high dose I was initially given…
This is a great account from an actual MM survivor. Two questions- may I use your post for a post about Dex and can you give me any more specifics about your dex experiences?
