Molgramostim is a recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) used as an immunostimulant. It is a glycoprotein that stimulates the proliferation, differentiation, and functional activation of hematopoietic progenitor cells, primarily neutrophils, monocytes, and macrophages. In the Indian context, it is a critical supportive therapy in oncology and hematology to manage chemotherapy-induced neutropenia and accelerate myeloid recovery post-bone marrow transplantation.
Adult: For BMT/Post-Chemotherapy Neutropenia: 250 mcg/m²/day administered as a 2-hour intravenous infusion or subcutaneous injection for 21 days. For PBPC Mobilization: 250 mcg/m²/day subcutaneously.
Note: Reconstitute 400 mcg vial with 1 mL of Sterile Water for Injection (without preservative). Gently swirl; do not shake vigorously. Use within 6 hours of reconstitution when stored at 2-8°C. Administer subcutaneously (preferred) or as a slow IV infusion over 2-4 hours. Rotate subcutaneous injection sites (abdomen, thigh, upper arm).
Molgramostim binds with high affinity to specific cell surface receptors (GM-CSFR) present on hematopoietic progenitor cells and mature cells of the myeloid lineage. This binding activates intracellular JAK/STAT, MAPK, and PI3K signaling pathways, leading to gene transcription that promotes cell proliferation, differentiation, and functional activation.
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 fatigue, dizziness, or headache. Patients should be cautioned about operating machinery or driving until they know how the drug affects them.
| Lithium | May potentiate the release of neutrophils; increased risk of neutropenia or leukocytosis. | Moderate |
| Corticosteroids (e.g., Prednisone) | May potentiate myeloproliferative effects; monitor blood counts closely. | Moderate |
| Chemotherapeutic Agents (e.g., Cyclophosphamide, Doxorubicin) | Concurrent use can increase myelosuppression. Administer Molgramostim at least 24 hours after last chemotherapy dose. | Major |
| Sympathomimetics (e.g., Epinephrine) | Theoretical risk of increased vascular side effects. | Minor |