Autologous and Allogeneic Bone Marrow Transplantation

LEUKINE (sargramostim) is generally well tolerated. In three placebo-controlled studies enrolling a total of 156 patients after autologous BMT or peripheral blood progenitor cell transplantation, events reported in at least 10% of patients who received IV LEUKINE (sargramostim) or placebo were as reported in Table 6.

Table 6: Percent of AuBMT Patients Reporting Events

No significant differences were observed between LEUKINE (sargramostim) and placebo-treated patients in the type or frequency of laboratory abnormalities, including renal and hepatic parameters. In some patients with preexisting renal or hepatic dysfunction enrolled in uncontrolled clinical trials, administration of LEUKINE (sargramostim) has induced elevation of serum creatinine or bilirubin and hepatic enzymes (see WARNINGS). In addition, there was no significant difference in relapse rate and 24 month survival between the LEUKINE (sargramostim) and placebo-treated patients.

In the placebo-controlled trial of 109 patients after allogeneic BMT, events reported in at least 10% of patients who received IV LEUKINE (sargramostim) or placebo were as reported in Table 7.

Table 7: Percent of Allogeneic BMT Patients Reporting Events

There were no significant differences in the incidence or severity of GVHD, relapse rates and survival between the LEUKINE (sargramostim) and placebo-treated patients.

Adverse events observed for the patients treated with LEUKINE (sargramostim) in the historically-controlled BMT failure study were similar to those reported in the placebo-controlled studies. In addition, headache (26%), pericardial effusion (25%), arthralgia (21%) and myalgia (18%) were also reported in patients treated with LEUKINE (sargramostim) in the graft failure study.

In uncontrolled Phase I/II studies with LEUKINE (sargramostim) in 215 patients, the most frequent adverse events were fever, asthenia, headache, bone pain, chills and myalgia. These systemic events were generally mild or moderate and were usually prevented or reversed by the administration of analgesics and antipyretics such as acetaminophen. In these uncontrolled trials, other infrequent events reported were dyspnea, peripheral edema, and rash.

Reports of events occurring with marketed LEUKINE (sargramostim) include arrhythmia, fainting, eosinophilia, dizziness, hypotension, injection site reactions, pain (including abdominal, back, chest, and joint pain), tachycardia, thrombosis, and transient liver function abnormalities.

In patients with preexisting edema, capillary leak syndrome, pleural and/or pericardial effusion, administration of LEUKINE may aggravate fluid retention (see WARNINGS). Body weight and hydration status should be carefully monitored during LEUKINE (sargramostim) administration.

Adverse events observed in pediatric patients in controlled studies were comparable to those observed in adult patients.

Acute Myelogenous Leukemia

Adverse events reported in at least 10% of patients who received LEUKINE (sargramostim) or placebo were as reported in Table 8.

Table 8: Percent of AML Patients Reporting Events

Nearly all patients reported leukopenia, thrombocytopenia and anemia. The frequency and type of adverse events observed following induction were similar between LEUKINE (sargramostim) and placebo groups. The only significant difference in the rates of these adverse events was an increase in skin associated events in the LEUKINE (sargramostim) group (p=0.002). No significant differences were observed in laboratory results, renal or hepatic toxicity. No significant differences were observed between the LEUKINE (sargramostim) and placebo-treated patients for adverse events following consolidation. There was no significant difference in response rate or relapse rate.

In a historically-controlled study of 86 patients with acute myelogenous leukemia (AML), the LEUKINE (sargramostim) treated group exhibited an increased incidence of weight gain (p=0.007), low serum proteins and prolonged prothrombin time (p=0.02) when compared to the control group. Two LEUKINE (sargramostim) treated patients had progressive increase in circulating monocytes and promonocytes and blasts in the marrow which reversed when LEUKINE (sargramostim) was discontinued. The historical control group exhibited an increased incidence of cardiac events (p=0.018), liver function abnormalities (p=0.008), and neurocortical hemorrhagic events (p=0.025).¹⁵

Antibody Formation

Serum samples collected before and after LEUKINE (sargramostim) treatment from 214 patients with a variety of underlying diseases have been examined for immunogenicity based on the presence of antibodies. Neutralizing antibodies were detected in five of 214 patients (2.3%) after receiving LEUKINE (sargramostim) by continuous IV infusion (three patients) or subcutaneous injection (SC)(two patients) for 28 to 84 days in multiple courses. All five patients had impaired hematopoiesis before the administration of LEUKINE (sargramostim) and consequently the effect of the development of anti-GM-CSF antibodies on normal hematopoiesis could not be assessed. Antibody studies of 75 patients with Crohn's disease receiving LEUKINE (sargramostim) by subcutaneous injection with normal hematopoiesis and no other immunosuppressive drugs showed one patient (1.3%) with detectable neutralizing antibodies. The clinical relevance of the presence of these antibodies are unknown. Drug-induced neutropenia, neutralization of endogenous GM-CSF activity and diminution of the therapeutic effect of LEUKINE (sargramostim) secondary to formation of neutralizing antibody remain a theoretical possibility. Serious allergic and anaphylactoid reactions have been reported with LEUKINE (sargramostim) but the rate of occurrence of antibodies in such patients has not been assessed.

Read the Leukine (sargramostim) Side Effects Center for a complete guide to possible side effects »

Interactions between LEUKINE (sargramostim) and other drugs have not been fully evaluated. Drugs which may potentiate the myelo proliferative effects of LEUKINE (sargramostim) , such as lithium and corticosteroids, should be used with caution.

REFERENCES

15. Buchner T, Hiddemann W, Koenigsmann M, et al. Recombinant human granulocyte-macrophage colony stimulating factor after chemotherapy in patients with acute myeloid leukemia at higher age or after relapse. Blood 1991; 78(5):1190-1197.

Last reviewed on RxList: 8/12/2008
This monograph has been modified to include the generic and brand name in many instances.