Sargramostim
Synonym :
GM-CSF
Mechanism :
Sargramostim is a colony stimulating growth factor which stimulates proliferation, differentiation, and functional activity of neutrophils, eosinophils, monocytes, and macrophages.
Indication :
- Acute myeloid leukemia (following induction chemotherapy): To shorten time to neutrophil recovery.
- Allogeneic bone marrow transplantation (myeloid reconstitution): Acceleration of myeloid reconstitution in pediatric patients 2 years of age and older.
- Allogeneic or autologous bone marrow transplantation (treatment of delayed neutrophil recovery or graft failure).
- Autologous peripheral blood progenitor cell and bone marrow transplantation.
- Hematopoietic radiation injury syndrome (acute).
- Off-label: Primary prophylaxis of neutropenia in patients receiving chemotherapy (outside transplant and AML) or who are at high risk for neutropenic fever.
Contraindications :
Hypersensitivity to human granulocyte-macrophage colony stimulating factor such as sargramostim, yeast-derived products, or any component of the formulation.
Dosing :
Use in children ≥2 years of age.
Allogeneic bone marrow transplantation (Myeloid reconstitution):
250 mcg/m²/day IV infused over 2 hours, do not initiate until the post marrow infusion ANC is <500/mm³, and continue until ANC >1,500/mm³ for 3 consecutive days. If WBC >50,000/mm³ or ANC >20,000/mm³, interrupt treatment or reduce the dose by 50%.
Allogeneic or autologous bone marrow transplantation (treatment of delayed neutrophil recovery or graft failure):
250 mcg/m²/day IV infused over 2 hours for 14 days.
Autologous peripheral blood progenitor cell transplantation (Myeloid reconstitution):
250 mcg/m²/day IV infused over 24 hours. Continue until ANC is >1,500/mm³ for 3 consecutive days.
Acute hematopoietic radiation injury syndrome:
<15 kg: 12 mcg/kg SC once daily.
15 to 40 kg: 10 mcg/kg SC once daily.
>40 kg: 7 mcg/kg SC once daily.
Adverse Effect :
Hypertension, edema, pericardial effusion, malaise, headache, chills, skin changes, hyperglycemia, weight loss, hypoalbuminemia, hypomagnesemia, diarrhea, nausea, vomiting, anorexia, UTI, hyperbilirubinemia, asthenia, arthralgia, raised creatinine, fever, pharyngitis.
Interaction :
Corticosteroids: May enhance the therapeutic effect of Sargramostim.
Cyclophosphamide: May enhance the adverse/toxic effect of Sargramostim.
Lithium: Sargramostim may enhance the adverse/toxic effect of Lithium.
Hepatic Dose :
Dose adjustment may be required, caution when administering is advised as hepatic disease may worsen.