Understanding Dexamethasone 2006

8/3/2019 Understanding Dexamethasone 2006

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Table of Contents

Introduction 5

What is Multiple Myeloma? 5

What are the Stages of Multiple Myeloma? 7

What is Dexamethasone, and

How Does it Work? 8

Dosages and Dose Scheduling Used

in Steroid Treatment 13

What Are Some Possible Side Effects

of Dexamethasone? 15

Can Other Drugs Interact

with Dexamethasone? 25

How Is Dexamethasone Given and

Are There Any Special Considerationsthat Need to Be Noted When Taking

Dexamethasone? 26

Are Other Corticosteroids Used

in the Treatment of Multiple Myeloma? 27

About the IMF 29

Glossary 32

2006, International Myeloma Foundation, North Hollywood, California


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Introduction

You have been given this booklet to learn

more about a drug called dexamethasoneas well as other drugs within the same classas dexamethasone: namely, the adrenalcorticosteroids (prednisone, prednisolone,and methylprednisolone). These drugs areused to treat multiple myeloma. After reading

this booklet, you should know the following:n What dexamethasone is

n How dexamethasone works

n The possible side effects ofdexamethasone

n How dexamethasone is given

n Similar details about the other adrenalcorticosteroids that are used in the treat-ment of multiple myeloma

This booklet is meant to provide you withgeneral information only. It is not meant to

replace the advice of your doctor, nurse, orother health-care practitioner. Your health-care team can answer questions related to

your specific treatment plan. All words thatappear in bold type are defined in a glos-sary at the end of this booklet.

What Is Multiple Myeloma?Multiple myeloma (also known as myelomaand plasma cell neoplasm) is a malignancyof the immunoglobulin-producing plasmacells found in the bone marrow. It is a malig-

nancy that involves the immune system. The


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The Stages of Multiple Myeloma

Stage I (low cell mass): Early disease.

The bone structure appears normal or closeto normal on x-ray images; the number ofred blood cells and amount of calcium in theblood are normal or close to normal; and theamount of M protein is very low

Stage II (intermediate cell mass): An

intermediate stage between stage I and IIIStage III (high cell mass): Moreadvanced disease. One or more of thefollowing are present:

n Anemia

n

A high level of calcium in the bloodn More than 3 areas of advanced lytic

bone lesions

n A high level of M protein in the bloodor urine

Multiple myeloma is a serious malignancy,

but it is treatable. Many patients experiencea series of responses, relapses, and remis-sions. New treatments may extend the aver-age survival of 5 years or more for patientsdiagnosed with multiple myeloma.

Following diagnosis, several options are

available for initial or front-line therapy. Forpatients who may be candidates for high-dosetherapy with transplant, various inductionregimens can be considered including thalid-omide with dexamethasone, dexamethasonealone, other dexamethasone-containing com-

binations, or combinations containing other

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malignant plasma cells, or myeloma cells,rarely enter the blood stream. The myelomacells accumulate in the bone marrow, caus-

ing the following:n Disruption of normal bone marrow

function, most commonly causing ane-mia (a low level of red blood cells in thebloodstream), although reduction inwhiteblood cell and plateletcounts can also

occurn Damage to bone surrounding accumu-

lated myeloma cells

n Release of an abnormal protein,monoclonal protein (M protein), intothe bloodstream

n Suppression of normal immune function,observed as reduced levels of normalimmunoglobulins and increasedsusceptibility to infection

Myeloma cells can also grow in the formof localized tumors or plasmacytomas.

Plasmacytomas may be single or multipleand either medullary (confined within bonemarrow and bone) or extramedullary (out-side of the bone). When there are multipleplasmacytomas inside or outside bone, thiscondition is also called multiple myeloma.

Confronted with a diagnosis of multiplemyeloma, it is important for your doctor todetermine the stage of the disease. Diseasestaging will help determine which parts ofthe body have been affected and to whatextent. This will allow the doctor to decide

upon the best treatment option.


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n Neoplastic diseases (malignancies), includ-ing some types of leukemia, lymphoma,and myeloma

nEdematous states, including numerous con-ditions associated with swelling through-out the body

Dexamethasone and other steroids, par-ticularly prednisone, prednisolone, andmethylprednisolone, have many uses in thetreatment of cancer. They suppress certainactions of the immune system and also inhibitcytokines, which are chemicals in the bodythat control inflammation. Dexamethasonedecreases inflammation or swelling by stop-ping white blood cells, which normally fight

infection, from traveling to areas of the bodywhere there is swelling. Its anti-inflammatoryactions can actually stop the swelling aroundtumors (especially on the spine, brain, andbone) and the resulting pain and other symp-toms caused by tumors pressing on nerve

endings.

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hypercalcemia (abnormally high levels ofcalcium caused by cancer)

n Rheumatic/collagen disorders, including

various types of arthritis, ankylosing spon-dylitis (inflammation of the spine and thesacroiliac joints), systemic lupus erythe-matosus (commonly referred to as lupus),and scleroderma

n Dermatologic diseases, including some

types of rashes, redness of the skin, andmycosis fungoides (lymphoma involvingthe skin)

n Allergic states, including those associatedwith asthma, dermatitis, drug hypersen-sitivity, perennial and seasonal allergies,

and serum sicknessn Ophthalmic diseases, including a number

of conditions that cause redness, swelling,and inflammation of the eyes and sur-rounding parts of the eyes

n Gastrointestinal (GI) diseases, such

as enteritis (inflammation of the smallintestine) and colitis (inflammation of thelarge intestine)

n Respiratory diseases, including asthma,chronic obstructive pulmonary disease,some types of pneumonia, and sarcoidosis

(inflammation of the lymph nodes andother organs)

n Hematologic disorders, including sometypes of anemia, purpura (bleeding justbelow the skin), and thrombocytopenia(low levels of platelets in the blood)

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Dexamethasone can also alter normalimmune system responses and is thereforeuseful in the treatment of conditions that

affect the immune system, such as certaintypes of anemia (for example, aplastic ane-mia and hemolytic anemia), thrombocytope-nia, and purpura.

Dexamethasone is useful in the treatmentof blood disorders and malignancies such

as multiple myeloma. It appears to causeprogrammed cell death, also known asapoptosis. This means that steroids such asdexamethasone can trigger the destructionof myeloma cells.

Dexamethasone typically is given with other

agents such as vincristine, doxorubicin,

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and thalidomide to treat multiple myeloma.It has been found that steroids can increasethe ability of chemotherapeutic and immu-

nomodulatory agents to destroy myelomacells. However, dexamethasone and othersteroids are sometimes used alone to treatthe disease. In fact, dexamethasone, givenin high doses, is the most active singleagent for treatment of multiple myeloma.

Treatment can sometimes bring about remis-sion. Dexamethasone thus offers severaladvantages and benefits. Response ratestypically are high with dexamethasone, butside effects can occur.

Dosages and Dose Scheduling Usedin Steroid Treatment

Front-Line TherapyDexamethasone is typically given alone or in combination with another agent suchas thalidomide (Thalomid), lenalidomide

(Revlimid), or bortezomib (Velcade) asfront-line therapy for myeloma. It is most oftengiven orally in 4-day pulses (usually, but notalways, 40 mg 4 days in a row with a vary-ing number of days off before the next dose:for example, 4 days on/4 days off; 4 days

on/10 days off; 4 days on once per month).Many oncologists are now prescribing dexa-methasone in a once-weekly cycle, often ata dose lower than 40 mg. Your doctor willwork with you to find a dosing schedule thatis well tolerated and appropriate to treat yourmultiple myeloma.

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What Are Some Possible SideEffects of Dexamethasone?

As is the case with any medication, use ofdexamethasone can cause some unwantedside effects. Few, if any patients, experienceall of these side effects. In fact, some patientsdo not experience any side effects at all whiletaking dexamethasone. There are certain

precautionary measures that patients andtheir health-care team should take in order toreduce or avoid the adverse effects. The mostimportant side effects and precautions aredescribed here. Members of your health-careteam can provide more information in greaterdetail about these and other possible sideeffects. They also can make recommendationsabout managing these side effects if, andwhen, they occur.

The chances of side effects caused bysteroids, including dexamethasone, increase

with length of treatment and dose of the medi-cation. In other words, the longer you take thedrug and the higher the dose you are taking,the greater are your chances of experiencingside effects. Most of the side effects can bereversed and will go away when treatment iscompleted. However, do not stop taking any

of your medications or reduce your doses onyour own. Speak to your health-care team ifyou are experiencing any side effects or if youhave any questions.

Below are some of the more common and/ormore serious possible side effects (listed by

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Maintenance TherapyThe steroid most commonly used as main-tenance therapy is prednisone. It is given

orally at 50 mg every other day. As withdexamethasone, the dose of prednisone canbe reduced. The goal is to determine a dos-age that will maintain a patients responsewithout causing side effects that compromisequality of life. Your hematologist/oncologist

will work with you to determine a dose thatbest suits your needs and tolerance.

Relapse TherapyDexamethasone is most frequently used inthis setting. The dosages and scheduling areas outlined for front-line approaches.


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Patients who have never had chickenpox or

measles should be especially careful to avoidexposure. If you are exposed to either illness, you should notify someone on your health-care team as soon as you become aware ofthe exposure. Patients taking dexamethasoneor any steroids also should avoid being vac-cinated. There are certain types of vaccinethat may be given if really needed. However,consult with your health-care team before

you receive any vaccines for any reason.They can tell you if the vaccine in question issafe for you to take.

Cardiac Conditions and Fluid RetentionUse of dexamethasone and other steroidscan cause increases in blood pressure, saltand water retention, and potassium and cal-cium excretion. These changes are more like-ly to occur when the drugs are taken in largedoses. Salt retention may lead to edema or

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body system affected), some precautionsworth remembering, and some tips on howto avoid or manage adverse events.

InfectionsBecause steroids block white blood cellsfrom reaching sites of infection, these agentsmay cause existing infections to get worse orallow new infections to occur. A paradoxiceffect is that the white blood cell level in the

blood increases because the cells are notexiting the bloodstream to enter infected tis-sues. Any drugs that suppress normal immuneresponses can make a person susceptible toinfections. Steroids may actually mask signsthat an infection is present. They may also

decrease a persons ability to fight the startof a new infection. Therefore, patients whoare taking steroids, including dexametha-sone, have an increased risk of all types ofinfections (bacterial, viral, or fungal).

Prevention and Treatment of Infections

Steroids, including dexamethasone, shouldnot be administered to a patient who hasa known infection. Nevertheless, there aresome situations in which steroids may beimportant or necessary during the time thatan active infection is being treated withappropriate antibiotics.

Any signs of an infection should be broughtto the attention of your health-care team assoon as they occur. Make sure you wash

your hands frequently, especially after beingin public places.

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swelling. You may notice that your anklesand feet are swollen. Fluid retention and lossof potassium can be a problem for patients

who have cardiac conditions, especially con-gestive heart failure and hypertension.

Prevention and Treatment of CardiacConditions and Fluid RetentionChanges in diet may be needed. You mayhave to restrict your salt intake and take

supplements to replace lost potassium andcalcium. Speak with your health-care teamwho will work with you to make sure that

you are eating the right foods and taking theproper supplements.

Dermatologic Effects

Patients taking dexamethasone or other ste-roids may notice that it takes longer thanusual for wounds to heal. Patients also maydevelop acne and rashes while taking dexa-methasone. Increased sweating is also seenin some patients during steroid therapy.

Prevention and Treatment of DermatologicConditionsBe careful when you cut or scratch yourself.Proper hygiene is important. Wash anywound and keep the area clean. If younotice that a cut or wound isnt healing

quickly or properly, you should call someoneon your health-care team. Also, do not useany over-the-counter products to treat woundsbefore consulting with a member of yourhealth-care team.

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Endocrine EffectsSteroids, including dexamethasone, may inter-fere with the way patients metabolize carbo-

hydrates and can cause blood glucose levelsto rise. This is especially important in patientswho have diabetes. Patients with known dia-betes can take steroids. However, additionaltreatment, including insulin therapy, may beneeded to control blood sugar levels.

Steroids can also cause menstrual irregularities.Prevention and Treatment of Endocrine EffectsPatients with diabetes may need to monitortheir blood glucose levels more frequently.These patients may need to adjust the dosesof their insulin or diabetes medications.

However, this decision needs to be made byhealth-care professionals and not by patientsthemselves. If you have diabetes, let the doc-tor who is treating your diabetes know that

you are taking dexamethasone.


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Patients of childbearing age should beadvised that the effects of steroids on thedeveloping child are unknown. Therefore,

women, especially those experiencing men-strual irregularities, should take added pre-cautions not to become pregnant while tak-ing dexamethasone.

Gastrointestinal EffectsSteroids can have various effects on your GI

tract. They increase the risk of GI perfora-tions. Therefore, patients who have pep-tic ulcers, diverticulitis, and ulcerative coli-tis should use corticosteroids cautiously tominimize the risk of perforation. For thesereasons, many physicians automatically rec-

ommend antacid therapy of some type forpatients taking steroids (eg, Pepsid).

Other possible GI side effects seen withdexamethasone therapy are increased ordecreased appetite, stomach bloating, nau-sea, vomiting, hiccups, and heartburn.

Prevention and Treatment of GastrointestinalEffectsTo avoid or minimize GI irritation, dexa-methasone should be taken with food orafter meals. Alcoholic beverages, whichalso irritate the stomach, should be avoided

while taking dexamethasone. Limiting intakeof caffeine-containing foods and drinks (suchas colas, coffee, tea, and chocolate) mayalso help. Eating small, frequent meals maydecrease nausea. Antacids taken betweenmeals may also be helpful but should not

be taken unless approved by someone on

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the health-care team. Treatment for persistenthiccups may require such prescription drugsas Thorazine or Phenergan. If you experi-

ence any GI adverse effects while takingdexamethasone, you should tell someone on

your health-care team. They can offer adviceon how to manage or avoid these unpleas-ant effects.

General Effects

Use of steroids, including dexamethasone,can cause weight gain.

Some patients may experience several days ofhoarseness. Usually this side effect wears off,but it may linger in patients who are taking fre-quent 4-day pulses of dexamethasone. Resting

the voice can help with this condition.Prevention and Treatment of Weight GainSome weight gain is to be expected dur-ing steroid therapy. Dexamethasone hasa tendency to increase patients appetites.Patients need to control their caloric intake.

Reduced carbohydrate intake is especiallyhelpful during steroid therapy. However, ifthere is a sudden, large weight gain (morethan 5 lbs over a day or 2), you should let

your health-care team know immediately.

Musculoskeletal Effects

Because steroids decrease calcium absorp-tion and increase its excretion, they affectbones. These effects can lead to pain andosteoporosis in adults. Therefore, patientsmost at risk for osteoporosis, especiallypostmenopausal women, should be cautious


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when taking large doses of steroids overlong periods of time. You may also experi-ence muscle pains because you may be

losing potassium.Prevention and Treatment of MusculoskeletalEffectsYou may have to take some type of supple-ments to replace the calcium and potassium

you are losing. Do not take any supplements

on your own, however. You can increase your calcium intake by eating foods thathave high calcium content. Foods such asmilk, cheese, yogurt, and other dairy prod-ucts and some vegetables are calcium richfoods. Bananas and some other fruits and

vegetables can be good sources of potas-sium. Consult with a member of your health-care team first, however, before you start tak-ing any supplements or change your diet.

Many patients with myeloma take bisphos-phonate therapy as treatment for myeloma-

related bone disease. This bisphosphonatetherapy also combats the negative effects ofsteroids upon bone strength and density.

Ophthalmologic EffectsProlonged steroid treatment may producecataracts, elevated intraocular pressure that

could lead to glaucoma, optic nerve dam-age, and eye infections.

Prevention and Treatment of OphthalmologicEffectsHave your eyes checked regularly. Anychange in vision should be reported immedi-

ately to your health-care team.

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Psychiatric and Neurologic EffectsSteroids can also cause irritability, moodswings, personality changes, and severe

depression. They also can cause insomnia.Emotional instability or psychotic tendenciesare aggravated and may become worse dur-ing steroid therapy.

Patients also have reported experiencingheadaches and dizziness.

Prevention and Treatment of Psychiatric andNeurologic EffectsContact someone on your health-care teamif you are experiencing any of the moodor personality effects listed above. Familymembers should be advised that you may be

more irritable and difficult to live with whenyou are receiving steroid therapy. If you arehaving problems sleeping, ask a member of

your health-care team if you can adjust thetime you take dexamethasone so it doesntinterfere with your sleep during the night.

Regular sleep medications can be helpfuland necessary for some patients.

Allergic ReactionsAllergic and hypersensitivity reactionsto steroids are possible in patients whoare susceptible or have had allergic respons-

es to other drugs. Allergic reactions caninclude difficulty breathing, closing of thethroat, swelling of lips and tongue, andhives. Such allergic reactions to steroids areexceedingly rare.


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Prevention and Treatment of AllergicReactions

Special precaution should be used beforeadministering dexamethasone or any othercorticosteroid to patients who have historiesof any type of allergic reactions to medica-tions. Be sure to alert your health-care teamif you have a history of allergic responses

when given any medication.Remember: speak with your doc-tor, nurse, or someone else on yourhealth-care team if you notice anychanges in your health.

Can Other Drugs Interactwith Dexamethasone?

Interactions with other medications are defi-nitely possible with dexamethasone. Patientswith multiple myeloma typically need to takea number of medications to treat the diseaseas well as other medical conditions that alsomay be present. Chances of drug interactions

increase with multiple medications. Below isa list of some (but not all) medications orclasses of medications that may interactwith dexamethasone. These interactions mayincrease or decrease the actions of any ofthe drugs. This is why its important to tell allmembers of your health-care team about allthe prescription and over-the-counter medica-tions, as well as herbal preparations andvitamins that you are taking.

Drugs That Can Interact with Dexamethasone andOther Corticosteroidsn Amphotericin B and diuretics that affect

potassium levels, such as amiloride, spi-ronolactone, and triamterene

n Antibiotics, such as erythromycin, clarithro-mycin, rifampicin, and azithromycin

n Anticoagulant medications, such as warfa-

rin and aspirinn Barbiturates, such as amobarbital, butal-

bital, pentobarbital, and secobarbital

n Diabetes medications, such as insulin,glibenclamide, metformin

n Cyclosporine

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n Digitalis

n Ephedrine, which is most commonly foundin weight-loss products

n Estrogen-containing medications, includingoral contraceptives and hormone- replace-ment therapy products

n Nonsteroidal anti-inflammatory drugs(NSAIDs), including aspirin, ibuprofen,indomethacin, and naproxen

n Phenytoin

How Is Dexamethasone Givenand Are There Any SpecialConsiderations That Need

to Be Noted When TakingDexamethasone?

Dexamethasone typically is given in aninfusion or orally, either with other anti-cancer agents or alone, to treat multiple

myeloma. The amount of dexamethasonepatients receive depends on many factors.However, to reduce the chances of sideeffects, the smallest dose necessary of dexa-methasone that can produce the desiredresponse should be used. Doses of dexa-methasone are decided by members of the

health-care team who are familiar with eachpatients medical history and case.

Dexamethasone can irritate the stomach;taking it with food can reduce the chancesof this happening. Alcohol should be usedcautiously or avoided altogether while taking

dexamethasone, as alcohol and dexametha-sone together can damage the stomachlining.

As with other glucocorticosteroids, dexameth-asone therapy cannot be stopped abruptly.It is necessary to stop this group of drugsgradually. Abrupt discontinuation can leadto withdrawal symptoms.

Your health-care team will manage howdexamethasone is administered to avoidor minimize adverse effects as muchas possible.

Are Other Corticosteroids Used

in the Treatment of MultipleMyeloma?

In addition to dexamethasone, other cortico-steroids often are used to treat patients withmultiple myeloma. These drugs are listedbelow.

NameBrand Names

of Corticosteroid

Prednisone Deltasone, Liquid Pred, Meticorten,Orasone, Prednicen-M, Sterapred,Sterapred DS

Prednisolone Orapred, Pediapred, Prelone

Methylprednisolone

Duralone

, Mediapred

, Medralone

,Medrol, Predacorten, Solu-Medrol

Because these drugs all belong to the sameclass of drugs namely, the glucocortico-steroids they act very similarly and canbe used to treat many of the same medical

conditions. They behave the same way

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About the IMF

One person can make a difference,

Two can make a miracle.Brian D. NovisIMF Founder

Myeloma is a little-known, complex, andoften misdiagnosed bone marrow cancerthat attacks and destroys bone. Myeloma

affects approximately 75,000 to 100,000people in the United States, with more than15,000 new cases diagnosed each year.While there is presently no known cure formyeloma, doctors have many approachesto help myeloma patients live better and

longer.The International Myeloma Foundation (IMF)was founded in 1990 by Brian and SusieNovis shortly after Brians myeloma diagno-sis at the age of 33. It was Brians dream thatfuture patients would have easy access to

medical information and emotional supportthroughout their battle with myeloma. Heestablished the IMF with the 3 goals of treat-ment, education, and research. He soughtto provide a broad spectrum of services forpatients, their families, friends, and health

care providers. Although Brian died 4 yearsafter his initial diagnosis, his dream didnt.Today the IMF reaches out to an internationalmembership of more than 125,000. The IMFwas the first organization dedicated solely tomyeloma, and today it remains the largest.

chemically in the body to treat diseases.Also, because they are so similar in theirmechanisms of action, many of the side

effects and associated precautions are thesame. Results of clinical trials have shownthese agents all to be equally effective in thetreatment of multiple myeloma.

The uses, side effects, precautions, and con-siderations described previously for dexa-

methasone are relevant for the entire classof corticosteroids and thus pertain to pred-nisone, prednisolone, and methylpredniso-lone. Prednisolone is actually a metabolite ofprednisone. Methylprednisolone, althoughstructurally similar, may be less toxic and

appears to be associated with less sodiumand fluid retention than prednisolone. Thus, itis worth discussing with the health-care teamif any particular type of steroid (eg, methyl-prednisolone vs dexamethasone) might bemore useful or appropriate in your care.

As with dexamethasone, the smallest dosenecessary of the corticosteroids that canproduce the desired response should be usedin order to avoid or minimize unwanted sideeffects.

For more information on multiple myeloma

and treatment options, contact the IMF.

IMF hotline:

USA & Canada only: 800-452-CURE (2873)

Elsewhere: 818-487-7455

IMF Web site: www.myeloma.org

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The IMF provides programs and services toaid in the research, diagnosis, treatment,and management of myeloma. The IMF

ensures that no one must brave the myelomabattle alone.

We care for patients today, while workingtoward tomorrows cure.

How Can the IMF Help You?

PATIENT EDUCATIONINFORMATION PACKAGE

Our free IMF InfoPack provides comprehensiveinformation about myeloma, treatment options,disease management, and IMF services. Itincludes our acclaimed Patient Handbook.

INTERNET ACCESSLog on to www.myeloma.org for 24-houraccess to information about myeloma, the IMF,education, and support programs.

ONLINE MYELOMA FORUM

Join the IMF Internet Discussion Group at

www.myeloma.org/listserve.html to share yourthoughts and experiences.

MYELOMA MINUTE

Subscribe to this free weekly email news-letter for up-to-the-minute information aboutmyeloma.

PATIENT & FAMILY SEMINARS

Meet with leading experts in myeloma treat-ment to learn more about recent advances intherapy and research.

MYELOMA MATRIX

On our website and in print, this document is acomprehensive guide to drugs in development

for myeloma.

MYELOMA TODAY NEWSLETTER

Our quarterly newsletter is available free ofcharge by subscription.

SUPPORTMYELOMA HOTLINE: 800-452-CURE (2873)

Toll-free throughout the United States andCanada, the IMF Hotline is staffed by trainedinformation specialists and is in frequent inter-action with members of our Scientific Advisory

Board.SUPPORT GROUPS

A worldwide network of more than 100 myelo-ma support groups hold regular meetings formembers of the myeloma community. The IMFconducts annual retreats for myeloma supportgroup leaders.

RESEARCHBANK ON A CURE

This DNA bank will provide genetic dataresearch in new drug development.

THE INTERNATIONAL STAGING SYSTEM (ISS)

This updated staging system for myeloma willenhance physicians ability to select the mostappropriate treatment for each patient.

RESEARCH GRANTS

Leading the world in collaborative researchand achieving extraordinary results, the IMF

Grant Program supports both junior and seniorresearchers working on a broad spectrum ofprojects. The IMF has attracted many younginvestigators into the field of myeloma, andthey have remained in the field and are activelypursuing a cure for this disease.

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GlossaryAlkylating agent: An agent that prevents the growth anddivision of new cancer cells by inhibiting their ability to

replicate DNA.

Adrenocortical steroid: Any of the steroidal hormones pro-duced by the adrenal cortex or their synthetic equivalents.Also known as adrenocorticoids, glucocorticosteroid, orcorticosteroid.

Alkylating agent: An agent that prevents the growth anddivision of new cancer cells by inhibiting their ability to

replicate DNA.Ankylosing spondylitis: A form of chronic inflammation ofthe spine and the sacroiliac joints.

Antibody: A protein produced by some of the bodys whiteblood cells that helps fight infection.

Apoptosis: The programmed death of a cell; believed tobe governed by chemical signals a given cell receives.

Bone marrow: A soft spongy tissue found in most largebones that produces red and white blood cells andplatelets.

Cell: The smallest unit of life. Millions of microscopic cellscomprise each body organ.

Colitis: Inflammation of the lining of the large intestine.

Cytokine: A growth factor produced by T-cells that stimu-lates the growth of T cells and B cells.

Edematous: Swollen with an excessive accumulation offluid.

Enteritis: Irritation or inflammation of the small intestine.

Hematologic malignancy: A cancer of the blood or bonemarrow.

Immunoglobulin: An antibody.

Immunomodulatory agent: Drug that affects, enhances, orsuppresses the immune system.

Lytic bone lesion: Dissolution or destruction of bone cellsleading to holes in bone.

Metabolite: A substance that is the product of the metabo-lism of another substance known as a parent compound

Monoclonal protein (M protein): An abnormal protein pro-duced by myeloma cells that accumulate in and damages

bone and bone marrow. A high level of M protein indi-cates that myeloma cells are present in large numbers.

Multiple myeloma: A cancer arising from the plasma cellsin the bone marrow. The plasma cells in patients withmultiple myeloma form abnormal antibodies, possiblydamaging the bone, bone marrow and other organs.

Mycosis fungoides: A blood lymphoma that stays mostly in

the skin and causes a rash.Plasma cell: A type of white blood cell that producesantibodies.

Plasmacytoma: A tumor made up of cancerous plasmacells.

Platelet: An element in the blood that helps with clotting,which in turn helps repair damaged blood vessels.

Protein: A group of compounds that are the main compo-nents of a cell.

Purpura: Bleeding that occurs just below the skin thatcauses purple spots and patches to appear because ofthe leakage of blood into the tissues under the skin

Red blood cell: A blood cell that carries oxygen from thelungs throughout the body.

Sarcoidosis: An inflammation of the lymph nodes andother organs.

Scleroderma: A connective tissue disorder characterizedby tightening of the skin of the arms, face or hands, puffyhands and feet, and joint stiffness and pain that can affectone part of the body or the entire body.

Serum sickness: A hypersensitive reaction caused by the

administration of a foreign serum; it causes fever, swell-ing, skin rash, and enlargement of the lymph nodes.

Side effect: An effect caused by the treatment with a drug.The term usually refers to an unwanted effect, but someside effects may be beneficial.

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Systemic lupus erythematosus (SLE): A chronic, inflamma-tory autoimmune disorder that can affect the skin, joints,kidneys, and other organs.

Thrombocytopenia: A low level of platelets in the blood.

These low levels can cause bruising or bleeding as wellas delay in the injury healing process.

Topical: pertaining to body surfaces such as the skin ormucous membranes

White blood cell: A cell made by the bone marrow thathelps fight infection and/or disease.

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AppointmentsDate Time Important Notes

Understanding Dexamethasone 2006

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