Sargramostim: Indications, Contraindications, and Side-Effects

Sargramostim (trade names Leukine or Prokine) is also referred to as GM-CSF, which stands for granulocyte-macrophage colony stimulating factor. Sargramostim is typically indicated for use in patients who have undergone cytotoxic (chemotherapeutic) or bone marrow transplant (BMT) treatments for acute myeloid leukemia (AML). In the post-chemotherapy/BMT AML patient, sargramostim stimulates the bone marrow production of white blood cells known as neutrophils, which make up approximately 50 to 70 percent of all white blood cells in the body.

Neutrophils destroy bacteria in the bloodstream, and these infection-fighting blood cells must exist in sufficient numbers to support a well-functioning immune system. Cytotoxic and BMT therapies for AML can result in significantly lowered neutrophil counts, and as a result, a cancer patient will be vulnerable to a host of infections and/or opportunistic diseases-many of which can be fatal. White blood cell replenishment is critical to the AML patient who, in lieu of accelerated neutrophil replenishment, will have to rely on an extended period of antibiotic administrations designed to prevent bacteria-based infections and disease.

Sargramostim is also indicated for use in AML patients who will undergo a peripheral blood stem cell transplant (PBSCT). Administered prior to a PBSCT, sargramostim will induce a patient's stem cells (non-developed or undifferentiated cells) to migrate outward from the bone marrow into the bloodstream where they can be harvested using a process known as apheresis. These stem cells will be stored for a reintroduction into the patient's blood subsequent to the completion of chemotherapies that will have destroyed cancer cells and healthy bone marrow cells alike. Once these undifferentiated stem cells are returned to the bloodstream, they serve to repopulate the bone marrow by developing into numerous types of normally functioning blood cells.

Contraindications and Side-Effects

Sargramostim is specifically indicated for patients with AML, and the drug should be avoided by individuals with other types of leukemia, as well as by individuals with certain types of fluid retention and buildup problems related to cardiac or pulmonary (lung) disease. Patients with abnormal kidney or liver functions will require close monitoring subsequent to administrations of sargramostim, and women who are pregnant or may become pregnant will have to consult with their physician prior to use of the drug, which may also be contraindicated in patients who have demonstrated an allergic reaction to yeast-based substances.

Sargramostim is characterized by numerous toxicities and it should never be administered except on the advice of a physician. The known side-effects of sargramostim include, but are not limited to: bone pain; weakness; muscle aches; chills; fever; fluid retention in numerous anatomical regions; reduced kidney and liver function; nausea and vomiting; abdominal pain; alopecia (hair loss); diarrhea; rashes; mouth sores; dizziness; shortness of breath; itching; headache; blood clots; cough; constipation, and pain at the injection site.

Source: Answers.com

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