Sargramostim

INTRODUCTION

Indications

Acceleration of bone marrow recovery after Autologous bone marrow transplantation in patients with non-Hodgkin's lymphoma, acute lymphoblastic leukemia, or Hodgkin's disease, Allogenic bone marrow transplantation from HLA-matched donors. Management of bone marrow transplant failure or engraftment delay. After induction chemotherapy for acute myelogenous leukemia (AML) in patients ≥55 yr. Mobilization and after transplant of autologous peripheral blood progenitor cells (PBPCs); increases harvest by leukapheresis.

Action

Consists of a glycoprotein produced by recombinant DNA technique that is capable of binding to and stimulating the production, division, differentiation, and activation of granulocytes and macrophages. Therapeutic Effects: Accelerated recovery of bone marrow after autologous bone marrow transplantation, resulting in decreased risk of infection and other complications.

Adverse Reactions/Side Effects

CNS: headache, malaise, weakness. Resp: dyspnea. CV: pericardial effusion, peripheral edema, transient supraventricular tachycardia. GI: diarrhea. Derm: itching, rash. MS: arthralgia, bone pain, myalgia. Misc: chills, fever, 1st-dose reaction.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report any rhythm disturbances or symptoms of increased arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.

• Be alert for signs of pericardial effusion, including chest pain, dyspnea, shortness of breath when reclining, dry cough, low grade fever, fainting, dizziness, tachycardia, and a feeling of anxiety. Report these signs to the physician.

• Assess any bone, joint, or muscle pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.

Interventions

• For patients with cancer who are medically able to begin exercise, implement appropriate resistive exercises and aerobic training to maintain muscle strength and aerobic capacity during cancer chemotherapy, or to help restore function after chemotherapy.

• Because of the risk of arrhythmias and pericardial effusion, use caution during exercise, and terminate exercise if patient exhibits untoward symptoms (chest pain, severe shortness of breath, fatigue), or displays other criteria for exercise termination (See Appendix L).

Patient/Client-Related Instruction

• Instruct patient or family/caregivers to report other troublesome side effects, including severe or prolonged headache, chills, fever, diarrhea, or skin problems (rash, itching).

Pharmacokinetics

Absorption: After IV administration, absorption is essentially complete. Well absorbed after subcut administration.