Sargramostim is a recombinant human granulocyte-macrophage colony-stimulating factor (GM-CSF) produced by recombinant DNA technology in a yeast (S. cerevisiae) expression system. It is a hematopoietic growth factor that stimulates the proliferation and differentiation of myeloid progenitor cells, leading to increased production of neutrophils, eosinophils, and monocytes/macrophages. In the Indian context, it is a critical supportive care agent used primarily in oncology and hematology to accelerate myeloid recovery following myelosuppressive chemotherapy or bone marrow transplantation.
Adult: 250 mcg/m²/day administered as a 2-hour intravenous infusion or subcutaneous injection. Dose may be adjusted based on neutrophil response. For BMT: 250 mcg/m²/day for 21 days. For AML: 250 mcg/m²/day starting 4 days after completion of chemotherapy.
Note: Reconstitute 500 mcg vial with 1 mL of Sterile Water for Injection (without preservative). Gently swirl; do not shake vigorously. Further dilute in 0.9% Sodium Chloride for IV infusion. Administer SC or as a 2-hour IV infusion. Do not co-administer with other drugs in the same line. Separate from chemotherapy/radiotherapy by at least 24 hours.
Sargramostim binds to specific cell surface receptors (GM-CSFR) on hematopoietic progenitor cells, activating intracellular signaling pathways (primarily JAK/STAT). This stimulates the proliferation, differentiation, and functional activation of myeloid lineage cells, including neutrophils, eosinophils, and monocytes/macrophages. It also enhances the phagocytic and cytotoxic activity of mature granulocytes and macrophages.
Pregnancy: Category C: Animal studies have shown adverse effects. There are no adequate and well-controlled studies in pregnant women. Use only if the potential benefit justifies the potential risk to the fetus.
Driving: May cause dizziness, fatigue, or malaise. Patients should be cautioned about driving or operating machinery if affected.
| Lithium | May potentiate the release of neutrophils; monitor for excessive leukocytosis. | Moderate |
| Corticosteroids (e.g., Prednisone) | May potentiate myeloproliferative effects; monitor WBC counts. | Moderate |
| Chemotherapeutic Agents (e.g., Cyclophosphamide, Doxorubicin) | Do not administer simultaneously. Sargramostim may increase sensitivity of myeloid progenitors to chemotherapy. Separate by at least 24 hours. | Major |
| Radiotherapy | Do not administer simultaneously. Separate by at least 24 hours. | Major |