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Sargramostim (Leukine®, GM-CSF)
Last Modified: April 20, 2012
Classification: Colony Stimulating Factor
Sargramostim is a type of colony stimulating factor, which is a group of medications that stimulate the production and function of blood cells. Granulocyte macrophage colony-stimulating factor (GM-CSF) is a protein produced by the body to increase production of certain white blood cells. Sargramostim is a man-made version of GM-CSF that stimulates white blood cell production, and in particular, neutrophil, macrophage, and dendritic cell production. These types of cells are responsible for fighting infection and are often decreased during cancer therapy. Neutrophils are the most abundant type of white blood cell and are the first to respond to fight infection. When the number of these neutrophils drops below 1000/mm3, it is called neutropenia and puts the patient at significant risk of infection. Macrophages fight infection by ingesting bacteria, but are longer acting than neutrophils. Dendritic cells make up only 1% of white blood cells, but are constantly scanning the area, notifying neutrophils and macrophages when they detect infection.
How to Take Sargramostim
Sargramostim is most often given as a subcutaneous injection (given under the skin), but can be given directly into a vein (intravenous, IV). It is given once a day, preferably at the same time of day, until the neutrophil count returns to normal. The actual dose is determined by your healthcare provider and is based on your body size. Sargramostim should be refrigerated. To lessen the sting of the injection, take it out of the refrigerator 30 minutes ahead of time. Sargramostim should be started no sooner than 24 hours after completion of chemotherapy.
Possible Side Effects of Sargramostim
There are a number of things you can do to manage the side effects of Sargramostim. Talk to your doctor or nurse about these recommendations. They can help you decide what will work best for you. These are some of the most common side effects:
Sargramostim stimulates the bone marrow to produce many white blood cells, which can lead to pain in the bones. This pain is often felt in the bones of the thighs, hips and upper arms. Your healthcare team may not want you to take acetaminophen (Tylenol®) because it can "mask" a fever, so talk to them about what pain relievers you can take.
Sargramostim can cause a low fever, but this could also be a sign of infection. Any fever (temperature > 100.4) should be reported to your healthcare team right away. Be sure you have a contact number for evenings and weekends, when the office is closed.
Irritation or Burning at the Injection Site
Some people experience redness, swelling, or itching at the site of injection. This is usually temporary. The injection is known to sting or burn if given when it is cold. Take the medication out of the refrigerator 30 minutes ahead of time to allow it to come up to room temperature before administration. Rotate the sites where the injection is given, inject slowly and/or numb the area with ice prior to giving the injection.
Low White Blood Cell Count (Leukopenia or Neutropenia)
White blood cells (WBC) are important for fighting infection. While receiving treatment, your WBC count can drop, putting you at a higher risk of getting an infection. You should let your doctor or nurse know right away if you have a fever (temperature greater than 100.4°), sore throat or cold, shortness of breath, cough, burning with urination, or a sore that doesn't heal.
Tips to preventing infection:
- Washing hands, both yours and your visitors, is the best way to prevent the spread of infection.
- Avoid large crowds and people who are sick (i.e.: those who have a cold, fever or cough or live with someone with these symptoms).
- When working in your yard, wear protective clothing including long pants and gloves.
- Do not handle pet waste.
- Keep all cuts or scratches clean.
- Shower or bath daily and perform frequent mouth care.
- Do not cut cuticles or ingrown nails. You may wear nail polish, but not fake nails.
- Ask your doctor or nurse before scheduling dental appointments or procedures.
- Ask your doctor or nurse before you, or someone you live with, has any vaccinations.
For more suggestions, read the Neutropenia Tip Sheet.
"First Dose Effect"
Following the first dose of sargramostim, there have been reports of difficulty breathing, flushing, low blood pressure, lightheadedness and elevated heart rate. These symptoms did not occur with future doses, but you should report this to your healthcare team immediately. This reaction is more common with intravenous administration of the drug.
Other Side Effects
Swelling and fluid retention (which can occur in the lungs or heart) have been reported. Patients receiving this medication should report any shortness of breath, cough, swelling in arms, legs or face to the healthcare team immediately.
The following side effects were also reported in clinical trials: decreased kidney function, elevation of liver enzymes (detected on blood tests) that resolve when the drug is stopped.