Treatment and the treatment process

Steroids

Steroids (corticosteroids) are among the main drugs in leukemia treatment, especially ALL. They act on leukemia cells and also help prevent many side effects.

Last updated: 14 October 2026~2 min read

On a dark navy background, a golden molecule passes through a lymphocyte’s membrane to the nucleus, where a switch of light turns on. — **Figure 1.**A steroid flips a "death switch" in the nucleus of a lymphoid cell.

01Short answer

The corticosteroids used in treatment — prednisolone, dexamethasone, methylprednisolone and hydrocortisone — are strong synthetic forms of cortisol, a hormone made by the adrenal glands. In lymphoid cells they bind a special receptor and trigger programmed cell death (apoptosis). This is why steroids are an important part of ALL induction and of the "pulses" during maintenance, as well as some CLL and lymphoma regimens. They are also used to prevent nausea, for allergic reactions, for differentiation syndrome in APL and for graft-versus-host disease after transplant. Side effects include increased appetite and weight, raised blood sugar, sleeplessness, mood changes, stomach irritation, a higher risk of infection and, with long use, bone and muscle problems.

02Simple explanation

Like a natural hormone. The body makes cortisol itself; the drug is a strong form of it.

Acting on leukemia. They kill lymphoid leukemia cells.

A supporting role. Also given for nausea and allergy.

Gradual stopping. After a long course the dose is lowered slowly.

03Scientific explanation

Mechanism: by binding the glucocorticoid receptor they change gene activity in the nucleus and induce apoptosis in lymphoblasts; an early steroid response (for example a "prednisolone response") is a prognostic sign in some protocols (NCI).

Dexamethasone and prednisolone: dexamethasone reaches the CNS better and is stronger, but the risk of infection and osteonecrosis may be higher; the choice depends on the protocol and age.

Long-term effects: osteonecrosis (especially in teenagers — hip and knee pain), osteoporosis, muscle weakness, cataracts, high blood pressure, steroid-induced diabetes and adrenal suppression. Pneumocystis prevention and stomach-protecting medicines are often given alongside.

04What happens in the body?

How do they work?

The steroid molecule enters a lymphoid cell, reaches the nucleus and switches on genes that tell the cell to "self-destruct". Healthy lymphocytes also fall, which raises the risk of infection.

Everyday effects

Steroids increase appetite, disturb sleep and can change mood — sometimes a burst of energy, sometimes irritability or sadness. Taking them in the morning with food can protect the stomach and sleep. Blood sugar may be checked.

Three calm glowing shapes — a drop, a crescent moon and a wave — on a dark background. — **Figure 3.**Steroids can affect blood sugar, sleep and mood.

Stopping

After a long course the adrenal glands "fall asleep". The dose is lowered gradually so they start working again. During this time an extra dose may be needed during illness or stress.

Translucent kidneys with small glowing adrenal glands on top on a dark background. — **Figure 2.**The adrenal glands make the body’s own steroids.

05A steroid course

A simplified outline.

1StartMorning, with food.

2MonitoringSugar, blood pressure, mood.

3ProtectionStomach, infections.

4TaperingGradual stopping.

Effect on leukemiaLymphoid cells.

SupportNausea, allergy.

FamilyUnderstanding mood changes.

06How steroids are used in leukemia

Purpose	Example	Note
Treating leukemia	ALL, CLL regimens	Prednisolone, dexamethasone
Preventing nausea	Before chemotherapy	A short course
Allergic reactions	Transfusions, drugs	Hydrocortisone
Differentiation syndrome	APL	Dexamethasone
Graft-versus-host disease	After transplant	Methylprednisolone
Eye protection	High-dose cytarabine	Steroid eye drops

* Your doctor sets the dose and length of the course.

07Key terms

Corticosteroid: A drug similar to cortisol.
Apoptosis: Programmed cell death.
Adrenal suppression: The body making less of its own hormones.
Osteonecrosis: Bone damage from a disrupted blood supply.
Steroid-induced diabetes: Raised blood sugar due to steroids.
Tapering: Lowering the dose step by step.

08Key points

Steroids are core drugs in ALL.
They kill lymphoid leukemia cells.
They also help with nausea and allergy.
They affect appetite, sleep and mood.
Sugar and the stomach are monitored.
Do not stop them suddenly.

09Frequently asked questions

Why am I so hungry?

Steroids increase appetite; healthy snacks and regular meals can help.

My child is very irritable — is that normal?

Yes, steroids can strongly affect mood; it passes after the course. Tell the team.

Will the weight go?

It usually falls gradually after the course ends.

What does hip pain mean?

It can be a sign of osteonecrosis; be sure to tell your doctor.

10Questions for your doctor

Take these questions to your appointment. The ones you save are collected on the “My questions” page and stay on this device only.

Why am I so hungry?
My child is very irritable — is that normal?
Will the weight go?
What does hip pain mean?

My questions

12Sources

National Cancer Institute (NCI). Chemotherapy to Treat Cancer
American Cancer Society. How Chemotherapy Drugs Work
Cancer Research UK. Chemotherapy
National Cancer Institute (NCI). Adult Acute Lymphoblastic Leukemia Treatment (PDQ) – Patient Version
MedlinePlus. Dexamethasone
NHS. Steroids
Leukemia & Lymphoma Society. Hairy cell leukemia
American Cancer Society. Treating Leukemia in Children
World Health Organization. CureAll framework: WHO Global Initiative for Childhood Cancer
Macmillan Cancer Support. Work and cancer: employees

Medical disclaimerThis information is for educational purposes only and does not replace medical advice.

Last updated: 14 October 2026← Back to the list

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