GM-CSF


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Related to GM-CSF: interleukin, Cytokines, Sargramostim

sargramostim (GM-CSF)

Leukine

Pharmacologic class: Granulocytemacrophage colony stimulating factor

Therapeutic class: Hematopoietic agent

Pregnancy risk category C

Action

Stimulates proliferation and differentiation of hematopoietic cells that activate mature granulocytes and macrophages of target cells

Availability

Liquid: 500 mcg/ml

Powder for injection: 250 mcg

Indications and dosages

Post peripheral blood progenitor cell (PBPC) transplantation

Adults: 250 mcg/m2/day I.V. over 24 hours or subcutaneously once daily, starting immediately after progenitor cell infusion

Mobilization of PBPCs into peripheral blood for collection by leukapheresis

Adults: 250 mcg/m2/day I.V. over 24 hours or subcutaneously once daily, continued throughout harvesting

Neutrophil recovery after chemotherapy in acute myelogenous leukemia Adults: 250 mcg/m2/day I.V. over 4 hours, starting 4 days after completion of chemotherapy induction

Bone-marrow transplantation failure or engraftment delay

Adults: 250 mcg/m2/day as 2-hour I.V. infusion for 14 days. If engraftment doesn't occur, may repeat after 7 days of drug hiatus.

Myeloid reconstitution after autologous or allogeneic bone-marrow transplantation

Adults: 250 mcg/m2/day as a 2-hour I.V. infusion, starting 2 to 4 hours after autologous bone marrow infusion and at least 24 hours after last chemotherapy or radiotherapy dose

Off-label uses

• Crohn's disease

• Melanoma

• Wound healing

• Mucositis

• Stomatitis

• Vaccine adjuvant

Contraindications

• Hypersensitivity to drug, its components, or yeast products

• Excessive leukemic myeloid blasts in bone marrow or peripheral blood (10% or more)

• Within 24 hours before or after chemotherapy or radiation therapy

Precautions

Use cautiously in:

• renal or hepatic insufficiency, fluid retention, pulmonary disorders, pulmonary infiltrates, heart failure, leukocytosis, transient supraventricular arrhythmias

• cancer patients undergoing sargramostim-mobilized PBPC collection

• patients receiving purged bone marrow or previously exposed to intensive chemotherapy or radiation therapy

• pregnant or breastfeeding patients

• children.

Administration

Don't give within 24 hours of chemotherapy or radiation therapy.

• Add 1 ml of sterile water to powder for injection by directing water stream against side of vial and swirling vial gently to disperse contents.

• Avoid shaking or agitating solution.

• For a final drug concentration below 10 mcg/ml, add human albumin 0.1% to saline solution; then dilute drug in normal saline solution.

• Infuse as soon as possible after reconstitution, but no more than 6 hours after mixing.

• Don't add other drugs to infusion; don't use in-line filter.

Adverse reactions

CNS: malaise, asthenia

CV: peripheral edema, tachycardia, hypotension, transient supraventricular tachycardia, pericardial effusion

GI: nausea, vomiting, diarrhea, anorexia, stomatitis, GI hemorrhage

GU: urinary tract disorder, abnormal renal function

Hematologic: blood dyscrasias, hemorrhage

Hepatic: hepatic damage

Musculoskeletal: joint pain, myalgia, bone pain

Respiratory: dyspnea, lung disorder

Skin: rash, alopecia

Other: fever, chills, sepsis, edema, first-dose reaction (respiratory distress, hypoxia, syncope, tachycardia, hypotension, flushing)

Interactions

Drug-drug. Corticosteroids, lithium: potentiation of myeloproliferative effects

Vincristine: severe peripheral neuropathy

Patient monitoring

• Monitor for dyspnea. Halve dosage and contact prescriber if dyspnea occurs.

• Assess CBC with white cell differential. Check for presence of blast cells, and watch for signs and symptoms of blood dyscrasias.

• Closely monitor vital signs and fluid intake and output. Stay alert for signs and symptoms of fluid overload.

Monitor liver function tests, and watch for evidence of hepatic damage and bleeding (especially GI hemorrhage).

Patient teaching

Tell patient sargramostim is a powerful drug that can cause significant adverse reactions. Teach him to recognize and report serious reactions at once.

Instruct patient to immediately report unusual bleeding or bruising or yellowing of skin or eyes.

• Tell patient drug may cause weakness and musculoskeletal pain.

• Inform patient that he'll undergo regular blood testing during therapy.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs mentioned above.

GM-CSF

GM-CSF

abbr.
granulocyte-macrophage colony-stimulating factor

CSF2

A gene on chromosome 5q23-q31 that encodes colony stimulating factor 2 (granulocyte-macrophage), a cytokine that controls the production, differentiation and function of granulocytes and macrophages.

Molecular pathology
CSF2 is localised to a cluster of related genes at chromosome 5q31, a region associated with deletions in the 5q- syndrome and acute myelogenous leukaemia.

GM-CSF

Granulocyte macrophage-colony stimulating factor, sargramostim, Leukine, Prokine A hematopoietic growth factor and immune modulator produced by granulocytes, macrophages, monocytes, lymphocytes, fibroblasts, endothelial cells; rGM-CSF–sargramostim may be used to ↑WBCs in AIDS, or stimulate hematopoiesis after high dose chemotherapy in autologous BMT; it may be used as an immune 'tonic' in CA and AIDS Pts, anemia, ↑ survival of BMTs, ↓ infections in congenital neutropenia Adverse effects Bone pain, rash, fever. See Biological response modifiers, Sargramostim. Cf G-CSF.

GM-CSF

Abbreviation for granulocyte-macrophage colony-stimulating factor.

Granulocyte/macrophage colony stimulating factor (GM-CSF)

A substance produced by cells of the immune system that stimulates the attack upon foreign cells. Used to treat prostate cancers as a genetically engineered component of a vaccine that stimulates the body to attack prostate tissue.
Mentioned in: Prostate Cancer
References in periodicals archive ?
Pulmonary alveolar proteinosis is a disease of decreased availability of GM-CSF rather than an intrinsic cellular defect.
Dual role of GM-CSF as a pro-inflammatory and a regulatory cytokine: implications for immune therapy.
Moreover, they showed that G-CSF and GM-CSF contribute to some adverse effects and resulted in a worsening of atherosclerosis.
He further noted, "Previous research has shown that mice with naturally higher levels of GM-CSF might be protected from the flu.
Generally, after 8-10 days culturing with GM-CSF, the suspended cells are used as DC and cells adherent to culture system are excluded in order to increase purity of BMDCs [11,12].
They also had higher levels of TNF[alpha], GM-CSF, and IL12(p70) than IBS patients and healthy controls but not CD patients.
Seeing that the MAPK pathway has been reported to participate in macrophage proinflammatory activation [7,8] and GM-CSF expression in various cells [9,10], we investigated the possible involvement of the MAPK pathway in AGEs inducing monocyte proliferation and proinflammatory activation.
The patient's serum was observed to have an inhibitory effect on GM-CSF signalling despite the paucity of anti-GM-CSF antibodies [10].
The correlation study was performed only with the significantly different cytokines (GM-CSF, IFN-[gamma], IL-4, and TNF-[alpha]) among TS COPD and TS CONTROL groups.
Measurement of NO, VEGF, GM-CSF, TNF-[alpha], IL-6, IL-8, and MCP-1 in the Conditioned Medium from EPCs.
While proinflammatory factors such as GM-CSF, IFN-[gamma], IL-9, and IL-15 can reduce the induction of apoptosis and extend the lifespan of the neutrophils from RA patients in vitro, both IL-8 and IL-18 show no effect on this phenotype [27, 28, 32, 57-59].