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

Abstract

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.