After patients with multiple myeloma go into remission with drug therapy, treating them with large doses of prednisone prolongs their remission and survival, according to a report in the journal Blood (Vol. 99, No. 9: 3163-3168).

Multiple myeloma is a cancer of the bone marrow that destroys bone, hampers blood production, and can damage kidneys. About 15,000 new patients are diagnosed each year in the US, according to the American Cancer Society.

It remains an incurable disease, with most patients dying within three to four years. Although it tends to strike older individuals, young people can also develop this disease.

A large number of patients will go into remission with chemotherapy. The problem facing doctors is how to keep them in remission. Many doctors have tried long-term "maintenance" chemotherapy or treatment with interferon. Neither of these has worked well enough.

Another approach has been high-dose chemotherapy followed by a transplant of the patient's stem cells. This helps prolong survival but does not cure patients, and it is toxic.

A study conducted by the Southwest Oncology Group and led by James R. Berenson, MD, looked for other ways of prolonging survival without the toxicity of a transplant procedure.

Most initial chemotherapy regimens for myeloma also contain prednisone or another cortisone-like steroid called dexamethasone. Berenson, a professor at UCLA School of Medicine and chief of cancer research at the West Los Angeles VA Medical Center, wondered whether long-term treatment with one of these drugs would help control the disease.

Berenson and his colleagues studied 126 patients with newly diagnosed myeloma who had received chemotherapy and gone into remission. Half the patients received a low dose of prednisone and the other half a high dose for as long as the disease remained in remission.

The medication was given every other day to lower the chance of side effects.

Patients receiving the higher dose of prednisone did better. Their remissions lasted an average of nine months longer (14 months vs. five months). Also, they lived an average of 11 months longer (37 months vs. 26 for the low-dose group).

But high doses of prednisone were toxic.

A small number of the patients receiving this treatment developed body swelling and facial swelling. These are well-known side effects of high doses of these kinds of drugs. Still, most patients did well and had few side effects.

The doctors concluded that this is a safe, well tolerated, and effective way to keep patients with multiple myeloma in remission.