Management of Airway Obstruction from Lymphoma

Initial Management and Dosing

• The American College of Physicians recommends administering dexamethasone slowly over several minutes to avoid perineal burning; if this occurs, slow or pause the infusion temporarily 1
• Once stabilized, oral and IV dexamethasone are equivalent (1:1 conversion), allowing transition to oral dosing 2

Administration and Monitoring

• The National Comprehensive Cancer Network suggests monitoring glucose levels for hyperglycemia, especially in diabetic patients 4
• Patients should be watched for GI symptoms, such as epigastric burning, and consider prophylactic proton pump inhibitor 4
• Sleep disturbances are a common side effect that may require adjustment of dosing schedule 4

Prevention of Infection

• The Infectious Diseases Society of America strongly considers antifungal prophylaxis for patients requiring steroids beyond 48-72 hours 3, 2

Tapering and Discontinuation

• The Endocrine Society recommends never abruptly discontinuing corticosteroids after more than a few days of treatment, and taper gradually to prevent adrenal insufficiency 2
• Adrenal suppression occurs even with short courses but typically resolves within 48 hours of discontinuation 3