Prednisone

[Hopez2]

Hi all,
I'm just looking for some info regarding prednisone dosage amounts of others who have had a bone marrow transplant, post tranplant @ about 9 months. My husband had a transplant in Aug. and his Dr. has him down to 7.5mg once a day now. He is thankfully in remission as of now. However, he has been extremely tired and week. He was sent to an endochronologist today. The Endo suggested uping the prednisone back to 10mg along with uping some other meds. The endo seems to think that at such a low dose, the prednisone's side-effects are minimal compared to the benefit of him having more energy. On the other hand, his oncologist has impressed upon us many times the need for him to get off of the steroid asap.
I would appreciate any insight from any of you who have been through this.

Thanks in advance,
Nicole

[Ruth Cuadra]

Hi, Nicole.

I'd say it's pretty remarkable to be down to 7.5mg/day of prednisone at 8-9 months after transplant. It took me more than a year to get down to about 10mg/day. I've never been able to get below 10mg/day because I have an adrenal insufficiency that pre-dates my aplastic anemia/MDS diagnosis. On top of that, a lower dose causes a flare of GVH symptoms, particularly in my mouth. I understand from my endocrinologist that 5mg-10mg/day is a basic replacement dose for what the body normally produces. I've been taking that much for most of my life with no ill effects on bone density or any of the other concerns usually expressed by transplant doctors and stated as reasons that patients should be tapered off as soon as possible.

Given that your husband is still feeling poorly after so many months, it may be worth giving the slightly higher dose of prednisone a try. The chances of incurring any long-term damage from a few months on 10mg are slim while the benefits to his overall well-being and recovery could be great. If and when he is able to taper off, it should be done very slowly--at the rate of 1mg per month or less.

Hope this helps.

Regards,
Ruth

[Hopez2]

Ruth,

Thank you so much for your speedy reply. Exactly what you said is kind of what I suspected after having talked to the endo. However, it's hard when you have 2 different Dr.s telling you 2 different things. His oncologist is know for being very aggressive in her post-transplant treatment, which we mostly like because my husband is only 33, so the sooner she can get him feeling somewhat normal, the better.
When was your transplant? How are you doing now? Did you have any long-term effects from it?

Regards,
Nicole

[mausmish]

My mother has been on Prednisone for 16 years for polymyalgia rheumatica (pmr). The rheumatologist keeps insisting that she needs to try to get down below 5 mg. but anything below 10 mg. her caregivers (my niece, my sister, and I) notice a big decline in her quality of life, even when tapering at 1 mg per month. She becomes weak, tired, and achy. She has fallen several times and never broken any bones - her bone density is fine. We encourage her to stay on 10 regardless of what the doctor says. She is 89-1/2 years old.

[Neil Cuadra]

Nicole,

Ruth is at a conference so I'll jump in and answer for her. She had her transplant in 1998 (you can read the whole story here). She's doing gerat and is considered cured of her MDS, although she has three residual problems: dry eyes from the radiation, which she treats with eye drops, an overly sensitive digestive system from GVHD (tongue, mouth, stomach), and persistent hand and foot cramps that we suspect are also from GVHD.

[Lisa V]

Is prednisone always part of the post-transplant protocol? My understanding is that with ATG it is given to protect against serum sickness, but what is its role with BMT, and why must it be continued for such a long time?

Just curious (this would be a big stumbling block if Ken ever went to transplant, as he can't tolerate the side effects).

[Ruth Cuadra]

Lisa,

I think the use of prednisone is a fairly standard part of most transplant protocols as an agent to prevent or reduce the severity of graft vs. host disease, but there is also a lot of variability in how much is used and for how long. Part of the variation is no doubt due to the fact that individual patients react so differently to it. Since Ken and, presumably, his doctors already know he can't tolerate prednisone, his transplant protocol would have to be adjusted.

Serum sickness is caused by an allergic reaction to ATG so prednisone, which is a corticosteroid, is given to try to prevent or reduce the severity of such a reaction.

Regards,
Ruth

[Lisa V]

Thanks, Ruth. I thought that cyclosporine would help reduce GVHD, or is that more to prevent graft rejection?

[Ruth Cuadra]

Cyclosporine and prednisone are immunosuppressants so they both play a part in keeping the patient's "old" immune system suppressed until the "new" one can take root during the transplant process. At the same time, these drugs are also trying to keep the "new" immune system from becoming too aggressive and attacking the patient's own body as a foreign irritant, which is what happens in graft vs. host disease. Getting the balance right between too much and too little immunosuppression is part of the art of medicine that our transplant doctors perform. There are also other drugs that can be used in the mix, including tacrolimus (Prograf), mycophenolate (CellCept), and methotrexate so there are a lot of options for tailoring a protocol for a specific patient.

Ruth