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Effects of Bacterially Synthesized Recombinant Human Granulocyte-Macrophage Colony-Stimulating Factor in Patients with Advanced Malignancy

Graham J. Lieschke, MBBS; Darryl Maher, MBBS; Jonathan Cebon, MBBS; Marian O'Connor, RN; Michael Green, MBBS; William Sheridan, MBBS; Andrew Boyd, MBBS, PhD; Michael Rallings, MBBS; Eric Bonnem, MD; Donald Metcalf, MD, PhD; Antony W. Burgess, PhD; Katherine McGrath, MBBS; Richard M. Fox, MBBS, PhD; and George Morstyn, MBBS, PhD
[+] Article, Author, and Disclosure Information

Requests for Reprints: George Morstyn, MBBS, PhD, Ludwig Institute for Cancer Research, Post Office Royal Melbourne Hospital, Melbourne, Victoria 3050 Australia.

Current Author Addresses: Drs. Lieschke, Cebon, Burgess, and Morstyn, and Ms. O'Connor: Ludwig Institute for Cancer Research, Post Office Royal Melbourne Hospital, Melbourne, Victoria 3050 Australia. Drs. Maher, Green, Sheridan, McGrath, and Fox: Royal Melbourne Hospital, Post Office Royal Melbourne Hospital, Melbourne, Victoria 3050 Australia.

Drs. Boyd and Metcalf: Walter and Eliza Hall Institute of Medical Research, Post Office Royal Melbourne Hospital, Victoria 3050 Australia.

Dr. Railings: Essex Laboratories, 11 Gibbon Road, Baulkham Hills, New South Wales 2153 Australia.

Dr. Bonnem: Clinical Research Division, Schering-Plough Corporation, Kenilworth, NJ 07033.

© 1989 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1989;110(5):357-364. doi:10.7326/0003-4819-110-5-357
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Study Objective: To define the clinical and hematologic effects of subcutaneously administered bacterially synthesized recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF).

Design: Single arm nonrandomized dose escalation study.

Patients: Twenty-one patients with advanced malignancy who were not receiving concurrent myelosuppressive therapy.

Interventions: Subcutaneous administration of rhGM-CSF by once-daily injection to groups of two to four patients at doses of 0.3 to 30 µg/kg body weight · d for 10 consecutive days. Some patients received a second 10-day period of daily rhGM-CSF treatment after a 10-day nontreatment interval followed by alternate-day treatment. Clinical status and hematologic values were monitored frequently.

Measurements and Main Results: All doses of rhGM-CSF caused an immediate transient fall of 84% to 99% in circulating neutrophils, eosinophils, and monocytes. Continued daily dosing caused a leukocytosis of up to 10-fold with increases in numbers of circulating neutrophils, eosinophils, monocytes, and lymphocytes. There appeared to be a plateau in the increase in neutrophils in the dose range 3 to 15 µg/kg · d. Marrow aspirates showed increased proportions of promyelocytes and myelocytes. Alternate-day injection of 15 µg/kg maintained a leukocytosis. At doses up to 15 µg/kg · d, rhGM-CSF was well tolerated but adverse effects included bone pains, myalgias, rashes, and liver dysfunction. At doses exceeding 15 µg/kg · d, pericarditis was a dose-limiting toxicity. Idiopathic thrombocytopenic purpura was reactivated by rhGM-CSF in one patient.

Conclusions: Bacterially synthesized rhGM-CSF induces a leukocytosis in the dose range of 3 to 15 µg/kg · d. These doses are appropriate for phase II studies.





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