What is the utility of prednisone (corticosteroid) in patients with Chronic Lymphocytic Leukemia (CLL)?

From the Guidelines

Prednisone is a valuable treatment option for patients with CLL, particularly for managing autoimmune complications such as autoimmune hemolytic anemia (AIHA) and immune thrombocytopenia, where it has been shown to be effective in most patients 1. When considering the use of prednisone in CLL patients, it is essential to weigh the benefits against potential side effects and consider the individual patient's risk factors and comorbidities.

• The primary use of prednisone in CLL is for the treatment of autoimmune cytopenias, with most patients responding to corticosteroids 1.
• In patients with autoimmune cytopenia, prednisone can be initiated at a dose of 1 mg/kg/day, with gradual tapering as the patient responds to treatment.
• For patients who do not respond to corticosteroids, alternative treatments such as splenectomy, monoclonal antibodies, or thrombopoietin analogs may be considered 1.
• It is crucial to monitor patients on prednisone for potential side effects, including hyperglycemia, hypertension, mood changes, and increased infection risk.
• Prednisone should be used cautiously in patients with diabetes, psychiatric disorders, or active infections, and always with appropriate prophylaxis against infections and bone loss when used for extended periods.
• The use of prednisone in CLL patients should be guided by the most recent clinical practice guidelines, which recommend its use in specific clinical scenarios, such as the treatment of autoimmune complications 1.

From the Research

Utility of Prednisone in Patients with CLL

• Prednisone is a commonly used treatment for autoimmune complications in CLL patients, including autoimmune hemolytic anemia (AIHA) 2, 3.
• In AIHA, prednisone is the first-line treatment, with a response rate of 90% and a complete response rate of 65% 3.
• However, more than 60% of patients relapse when treatment is stopped, and alternative treatments such as intravenous immunoglobulin, cyclosporine A, and rituximab may be necessary 2, 4, 3.
• Prednisone is also used in combination with other treatments, such as chlorambucil, cyclophosphamide, and vincristine, for the treatment of advanced CLL 5.
• The use of prednisone in CLL patients has been shown to improve symptoms and quality of life, but its impact on overall survival is unclear 6, 5.

Autoimmune Complications in CLL

• CLL patients are at increased risk of developing autoimmune complications, including AIHA, pure red cell aplasia, and autoimmune thrombocytopenia 2, 3.
• These complications can be life-threatening and require prompt treatment with immunosuppressive agents, such as prednisone 2, 4, 3.
• The pathogenesis of autoimmune complications in CLL is multifactorial and involves immune dysregulation, leading to loss of tolerance to self-antigens 2, 3.

Treatment of CLL

• The treatment of CLL depends on the stage and severity of the disease, as well as the presence of autoimmune complications 6, 5.
• First-line treatments for CLL include covalent Bruton tyrosine kinase (BTK) inhibitors, B-cell leukemia/lymphoma 2 (BCL2) inhibitors, and combination regimens containing rituximab and chemotherapy 6.
• Prednisone may be used in combination with these treatments to manage autoimmune complications and improve symptoms 2, 4, 5.