Conventional Dose Steroid Research Articles

Comparison of conventional dose steroid treatment and high dose steroid treatment as run-in regime for splenectomy in immune thrombocytopenic purpura (ITP)

Background Splenectomy is a treatment procedure for ITP which is being used for more that 50 years and is still considered as the best option for the treatment of the condition. The facts that frequent monitoring is not required and that medical treatment is not indicated following splenectomy in most cases are among the major advantages of the procedure. Aim of the study To compare the conventional dose steroid and high dose steroid treatments as run-in regime for splenectomy in patients diagnosed with ITP. Methods The conventional dose steroid (1 mg/kg, n = 20) and high dose steroid treatments (30 mg/kg, n = 30) were applied to 50 cases with ITP between 1998 and 2008 in our clinic. Results: High dose steroid produced higher platelet count on days 3, 5, and 7 compared to conventional dose steroid. There were no differences between the groups in terms of adverse effects. Treatments were discontinued after the operation by rapidly reducing the dose. Postoperative values regarding response to splenectomy were comparable in both groups. Conclusions Both higher and earlier responses obtained with high dose steroid may be significant in reducing hospitalization period of patients and eliminating life-threatening platelet values within the shortest time possible.

Comparison of Megadose Methylprednisolone Versus Conventional Dose Prednisolone in Hematologic Disorders

Glucocorticoids (GCs) are known for their clinically useful effects in immunologic and inflammatory disorders. Although there is a huge volume of knowledge concerning the cellular and molecular effects of GCs, statements regarding their effects in multiple diseases at variable doses are not clear-cut owing to pharmacogenetic differences. The main actions of GCs in hematologic disorders have been related to their differentiation-inducing and apoptosis-inducing effects, but modification of several steps of the hematopoietic and/or immune pathway has also been reported. In our clinic, mega-dose methylprednisolone (MDMP) has been successfully used for treatment of different hematologic diseases, such as leukemias, bone marrow failure in aplastic anemia, hypoplastic anemia, myelodysplastic syndrome, neutropenia, autoimmune diseases, and in some congenital hereditary diseases. Both clinical and experimental studies in our department revealed that MDMP was more effective than conventional dose steroids. It is interesting that MDMP can be curative in some congenital hereditary diseases such as Diamond-Blackfan syndrome. However, more research is required to clarify their roles in biology, physiology, and molecular genetics.

Thrombotic thrombocytopenic purpura in southern Turkey: a single-center experience of 29 cases

In this retrospective, nonrandomized study, we describe our experience in the management of 29 consecutive patients with thrombotic thrombocytopenic purpura (TTP) treated with a combined therapy of plasma exchange (PE) and steroids at a single center. We compared the effectiveness of high-dose steroids (20-25 mg/kg methyl prednisolone) as first-line treatment in combination with PE therapy with the combination of standard-dose steroids (1 mg/kg methyl prednisolone) and PE in adult patients with TTP. Clinical, laboratory data and treatment outcomes such as response rate, median time to recovery and survival were evaluated retrospectively. Overall (OR) and complete (CR) response rates were 69 and 52% respectively. Similar response rates were found in patients treated with pulse or conventional dose steroids; however, the median time to response was delayed in the high-dose methyl prednisolone (HDP) group. The median time from the initiation of symptoms to initiation of treatment was approximately 15 days (range: 0-30). Delayed treatment in our patients because of delayed referral to our center resulted in poor response to treatment. In all, four of 14 (27%) complete responders experienced relapses. The predicted relapse rate was 48% at a median of 30 months. All the relapses presented with a combination of thrombocytopenia and microangiopathic hemolytic anemia. This analysis showed that high-dose steroid treatment did not prove to be beneficial for TTP patients as firstline therapy combined with PE. Moreover, pulse steroid interventions might have resulted in delayed responses and our data suggest that initiation of treatment with PE should not be delayed.

Metamizole Sodium-Induced Severe Aplastic Anemia and its Recovery with a Short-Course Steroid Therapy

The authors treated a girl with severe aplastic anemia that developed following urinary tract infection. She was referred to our hospital for bone marrow transplantation. The detailed medical history of the patient revealed iatrogenic metamizole sodium overdose that was given during her infection. She responded to a 3-day, high-dose methylprednisolone therapy and consequent conventional dose steroid. The authors observed at first partial and subsequently complete remission of all the hematologic parameters of the patient within 30 days and 4 months, respectively. This case suggests that the history of drug use should be questioned carefully in the patients with aplastic features. Steroid treatment may be an appropiate alternative therapy for aplastic anemia if associated drug use is detected in the medical history.

The effects of high dose methylprednisolone on apoptosis in children with acute lymphoblastic leukemia.

Rapid leukemic cell kill at initial diagnosis of patients with acute lymphoblastic leukemia (ALL) has been shown to be associated with a favorable outcome. The aim of the present study was to investigate the effect of high dose methylprednisolone (HDMP) on in vivo blast cell apoptosis in children with ALL. Annexin V-binding and Fas (CD95), Fas ligand (FasL; CD95L), and Bcl-2 expression in PB blasts were determined in newly diagnosed children with ALL before and 4, 24, 96 h after initiation of HDMP treatment (n=20) or conventional dose steroids (CDS) (n=10) as the control group. A decrease in absolute blast count (from 40.8 x 09 to 21.4 x 109/l) associated with an increase in apoptosis (14.2 to 26.9%) (P < 0.05) was detected 4 h after initiation of HDMP. A significant increase in Fas and FasL expression was detected 96 h after HDMP. There was no significant change in apoptosis, Fas and FasL expression from baseline in the control group treated with CDS. The changes in Bcl-2 expression after treatment was not significant in both groups. The results of this preliminary study have shown that HDMP treatment was effective in inducing immediate (within 4 h) blast cell apoptosis. The contribution of Fas/FasL interaction in the rapid component of cell kill remains to be determined, as the increase in the expression of these molecules was evident later.

The Dose Related Effect of Steroids on Blast Reduction Rate and Event Free Survival in Children with Acute Lymphoblastic Leukemia

We examined the effect of high-dose methylprednisolone (HDMP) on blast reduction rate and compared it to conventional dose steroid treatment, administered during the first 7+ days of the induction remission period in patients with acute lymphoblastic leukemia (ALL). In our previous randomized study, the event free survival (EFS) was found to be higher in patients treated with HDMP (Group B) than in patients treated with a conventional dose of steroids (Group A). We used the chemotherapy protocol for ALL patients according to the St Jude Total XI study group. Medical records of all 194 patients who achieved complete remission were reviewed to determine the absolute blast count (ABC) in peripheral blood smears from day 0 of treatment until day 8. A target response of 1000 blast/mm 3 was employed. The time in which ABC remained ≥ 1000/mm 3 and the EFS rates were assessed in group A (n =44) and B (n =51) of high risk patients. Group A and B patients were branched to chemotherapy schedules (A1, B1: steroid+vincristine+daunorubicine+intrathecal+ 3 doses l -asparaginase; A2, B2: steroid+vincristine+daunorubicine+intrathecal; A3, B3: only steroid monotherapy). Number of patients from whom the ABC remained ≥ 1000/mm 3 during all 7 days of induction treatment and the median number of days for blasts to reach the target level were significantly lower in group B1 than A1 (p <0.05), concordantly the 8-year EFS was higher in group B1 (p =0.01). In comparison of the subgroups, results of A2 and A3 were worse than of group B2 and B3. These findings strongly suggest that the effects of HDMP on blast cytoreduction and EFS are more potent than conventional dose steroids.

Delayed optic nerve decompression for indirect optic nerve injury.

To test the efficacy of delayed optic nerve decompression in traumatic optic nerve injury. Critical analysis of Proforma-based, prospectively accrued data of all cases with injury to surgery interval of greater than 2 weeks. Thirty-five cases with a median injury to surgery interval of 56 days (range, 16-374 d). Surgical decompression was undertaken only in cases that continued to have poor vision after treatment with steroids in conventional doses (1 mg/kg prednisolone). Pre- and postoperative visual acuity measurements were converted to the logMAR scale of visual acuity and the percentage of visual improvement was calculated. Surgery was universally unrewarding in all 9 cases with persistent and complete blindness of greater than 2 weeks and no response to steroid therapy. Of the cases with some residual vision, 20 of 26 cases improved (mean percentage improvement, 41.0 +/- 5.7%). Cases were categorized on the basis of the injury to surgery interval into groups of 2 weeks to 2 months, 2 months to 4 months, and greater than 4 months. No significant difference was demonstrated in the probability or quantum of improvement in these groups (P =.97). Optic nerve decompression remains useful as a salvage procedure for conventional dose steroid failed cases of traumatic optic neuropathy. In cases that are not completely blind, vision can be improved even when surgery is undertaken a few months after the injury.

Effective treatment of painful bone crises in type I gaucher's disease with high dose prednisolone.

In type I Gaucher's disease, episodes of severe disabling bone pain, the so called bone crises, may be resistant to all analgesics, including narcotics. The demonstration of subperiosteal oedema on magnetic resonance imaging (MRI) led to an attempt to use steroids to relieve the oedema and thereby the pain. On eight occasions, five patients with documented bone crises received conventional dose steroids (20 mg/m2/day) with considerable shortening of the attacks. On six occasions five further patients received high dose methylprednisolone (30 mg/kg intravenously or 1 g/m2 orally daily for two days), which was followed by oral prednisone for three to five days on the last four occasions. In this later group, pain relief was evident within several hours. Three treatments were given on an ambulatory basis. The MRI scan of one of these patients showed no subperiosteal fluid collection five days after high dose steroids had been started, and on subsequent x ray examination, there was no periosteal elevation. This treatment should be considered in cases of Gaucher's disease with bone crises.