Leukine
Leukine (sargramostim) helps your body grow new blood cells or recover from low blood cell counts. This can help lower your risk of other complications, such as infection. Leukine (sargramostim) can be used after certain types of chemotherapy, bone marrow transplant, or radiation. It's given as an injection daily, either through the veins or under the skin. This medication is only available as a brand name, there's currently no lower-cost generic version. Common side effects of Leukine (sargramostim) include fever, diarrhea, and lack of energy.
What is Leukine (sargramostim) ?
What is Leukine (sargramostim) used for?
- Growth or recovery of new blood cells after:
- Chemotherapy to treat certain types of blood cancers (adults age 55 years and older)
- Bone marrow transplant (adults and children ages 2 years and older)
- To prepare the body for stem cell collection for stem cell transplant (adults only)
- Raise the chance of survival after exposure to acute radiation (adults and children)
How Leukine (sargramostim) works
Leukine (sargramostim) is a granulocyte-macrophage colony-stimulating factor (GM-CSF). It works like the naturally occurring GM-CSF protein in your body to stimulate (trigger) bone marrow to make neutrophils, a type of white blood cell that helps your body fight infections.
Drug facts
Side effects of Leukine (sargramostim)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Fever (95%)
- Nausea (90%)
- Diarrhea (89%)
- Vomiting (85%)
- Blisters or sores in sensitive skin areas (75%)
- Hair loss (73%)
- Weakness or lack of energy (up to 66%)
- Low appetite or stomach-related problems (up to 54%)
- Rash (44%)
- Swelling (34%)
- Stomach bleeds (27%)
Less Common Side Effects
- Mouth sores
- Trouble breathing
- Bleeds
- Urinary tract infections
Please note: These side effects were reported in clinical trials by people who received Leukine (sargramostim) after bone marrow transplant. The side effects you experience might be different if you're being treated for a different condition.
Leukine (sargramostim) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Infusion-related reactions: trouble breathing, flushing, dizziness, fainting, fast heartbeat
- Serious allergic reaction: rash, swelling around your mouth or eyes, trouble breathing, wheezing
- Too much body fluid: sudden weight gain, welling in feet or ankles, trouble breathing, dizziness, feeling tired
- Abnormal heart rhythm
The following Leukine (sargramostim) side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Black, tarry stools
bloating or swelling of the face, arms, hands, lower legs, or feet
blood in the eye
bloody nose
blurred vision
body aches or pain
bone pain
cloudy urine
congestion
decrease in urine output or decrease in urine-concentrating ability
difficult or labored breathing
drowsiness
dryness or soreness of the throat
fast, pounding, or irregular heartbeat or pulse
flushed, dry skin
fruit-like breath odor
hoarseness
increased hunger
increased thirst
increased urination
irregular heartbeat
large amount of cholesterol in the blood
loss of appetite
mood or mental changes
rapid weight gain
redness in whites of eyes
stomach pain
sweating
tender, swollen glands in the neck
tightness in the chest
tingling of the hands or feet
trouble with swallowing
trembling
twitching
unusual tiredness or weakness
unusual weight gain or loss
voice changes
vomiting
vomiting of blood or material that looks like coffee grounds
yellow eyes or skin
Incidence not known
Chills
confusion
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
general feeling of illness
headache
pain in the chest, groin, or legs, especially the calves
severe, sudden headache
slurred speech
sudden loss of coordination
sudden, severe weakness or numbness in the arm or leg
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
difficulty in moving
fear or nervousness
itching skin
lack or loss of strength
muscle pain or stiffness
pain in the joints
trouble sleeping
Incidence not known
Bleeding, blistering, burning, coldness, discoloration of skin, feeling of pressure, hives, infection, inflammation, itching, lumps, numbness, pain, rash, redness, scarring, soreness, stinging, swelling, tenderness, tingling, ulceration, or warmth at the injection site
feeling of warmth
redness of the face, neck, arms, and occasionally, upper chest
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
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Pros and cons of Leukine (sargramostim)
Pros
- Stimulates the growth of many different cells
- When used for exposure to radiation, it can be used in people of all ages
- Doesn't have a risk of ruptured spleen or sickle cell crisis like G-CSF medications (e.g., Neupogen (filgrastim))
Cons
- Can only be used after induction chemotherapy for AML in people age 55 years and older
- Can cause bone pain
- Not available as a generic
Pharmacist tips for Leukine (sargramostim)
- You might be able to receive Leukine (sargramostim) at home if your healthcare provider says it's safe to do so. If you're going to inject the medication at home, make sure you or your caregiver understand how to use the medication properly before leaving your provider's office.
- Don't change your dose or stop this medication without first talking to your provider.
- Leukine (sargramostim) shouldn't be given within 24 hours of chemotherapy or radiation. Make sure you know your treatment schedule and know when you should administer Leukine (sargramostim)
- If you miss or forget your dose, contact your provider for further instructions.
- Store Leukine (sargramostim) in the refrigerator (not in the freezer). Keep it in its original container to protect it from light, and don't shake it.
- Check each vial before using the medication. Don't inject if Leukine (sargramostim) contains any particles (solid chunks), flakes, is discolored, or foamy.
- Once the vial of Leukine (sargramostim) is opened, it can be kept in the refrigerator for 20 days. It can be helpful to write the date that you first used the vial or the date it will expire. Discard any remaining solution after 20 days.
- Don't reuse needles, and throw them away in a sharps container after use to prevent needlestick injuries.
Common questions about Leukine
Your provider will let you know when it's safe to start Leukine treatment. The timing can differ depending on why you're receiving this medication. For example, if you're receiving Leukine after chemotherapy, your provider might ask you to wait 24 hours or longer after the end of your chemotherapy to begin treatment. Ask your provider when you'll begin Leukine.
Nausea is a common side effect of Leukine reported by people in clinical studies. But it's tough to tell whether the nausea is caused by Leukine or another medication. For example, in a study of people who received Leukine and placebo after bone marrow transplant, both groups reported nausea as a common side effect. If you feel nauseous after your dose, talk with your provider.
Leukine can be given as a slow IV infusion through the veins or as an injection under the skin, depending on your medical condition. If you're getting Leukine as an IV infusion, your healthcare provider will give it to you in a hospital or clinic setting. If you're receiving Leukine as an injection under the skin, you might be able to give yourself the injection if your provider says its safe to do so. The injection can be given under the skin around your stomach, thigh, or outer area of your upper arms. Rotate the injection sites every day. Avoid injecting the medication in areas that are tender, red, bruised, hard, or scarred.
GM-CSF medications like Leukine stimulate your body to make many different types of blood cells, such as neutrophils, monocytes, and eosinophils. G-CSF medications like Neupogen (filgrastim) only stimulate your body to make neutrophils. Your provider will determine which therapy is better for you depending on your specific treatment plan.
There are some forms of the Leukine injection solution that contain benzyl alcohol as a preservative. If you're pregnant or giving the medication to a newborn or infant, there's a lyophilized powder form of the medication that's mixed with sterile water for injection. Your or your child's provider will likely use this form to avoid unwanted benzyl alcohol exposure.
Leukine is made from yeast and can cause an allergic reaction in some people. Let your provider know if you've ever had a severe allergic reaction to products made from yeast.
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Risks and warnings for Leukine (sargramostim)
Leukine (sargramostim) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Allergic and infusion-related reactions
Leukine (sargramostim) can cause infusion reactions after the first dose in any given cycle. Symptoms include trouble breathing, flushing, low blood pressure, fainting, and/or fast heartbeat. Your healthcare team will monitor for signs of this reaction and might slow down your infusion rate if you start to show symptoms. Usually symptoms don't happen again after the first dose within each cycle.
Additionally, Leukine (sargramostim) can cause serious allergic reactions. Get medical help right away if you notice a rash, swelling in your face or throat, or trouble breathing.
Capillary leak syndrome (CLS) and swelling
- Risk factors: History of fluid retention | Heart failure
Though not common, Leukine (sargramostim) can cause capillary leak syndrome (CLS) or swelling. Your provider will keep track of your body weight during treatment. Talk to your provider if you notice dizziness, lightheadedness, or unexplained swelling in your body or weight gain. If so, your provider might need to pause or lower the dose of Leukine (sargramostim) , or give you a water pill to ease swelling.
Changes in heartbeat
- Risk factors: History of heart arrhythmia
There have been reports of people taking Leukine (sargramostim) who have had changes in their heartbeat. It's more common in people who have a history of irregular heartbeats and will usually go away after the medication is stopped.
Cancer risk
Leukine (sargramostim) is a growth factor, which means there's a possibility for it to promote the growth of other tumors (myeloid cell lines). Your providers will monitor your labs closely and might stop the medication if the risks become greater than the benefits.
Gasping syndrome in infants
- Risk factors: Using Leukine (sargramostim) in neonates and low birth weight infants
Leukine (sargramostim) injection solution contains a preservative called benzyl alcohol. This preservative can cause a serious side effect in newborn babies and children known as "gasping syndrome." This condition causes trouble breathing and can lead to death. To prevent benzyl alcohol exposure to your unborn baby during pregnancy or to children taking Leukine (sargramostim) , your provider will use the lyophilized powder form of the medication that's mixed with sterile water for injection instead.
Leukine (sargramostim) dosage
Vial| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 250mcg | 7 vials | $2,120.55 | $302.94 |
Typical dosage for Leukine (sargramostim)
Leukine (sargramostim) is usually given in a hospital or clinic setting by a healthcare provider. It's typically given as a slow infusion through the veins, but sometimes it's given as an injection under the skin. Your provider will determine the dose based on your body surface area (BSA), which takes into consideration your height and weight.
The typical dose of Leukine (sargramostim) is 250 mcg/m2 daily. When you'll start this medication, how you'll receive it, and the length of your treatment will depend on why you're taking Leukine (sargramostim) .
Interactions between Leukine (sargramostim) and other drugs
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Alclometasone
- Aldosterone
- Amcinonide
- Beclomethasone
- Betamethasone
- Budesonide
- Ciclesonide
- Clobetasol
- Clobetasone
- Clocortolone
- Cortisone
- Deflazacort
- Desonide
- Desoximetasone
- Dexamethasone
- Diflorasone
- Diflucortolone
- Difluprednate
- Flucloronide
- Fludrocortisone
- Flumethasone
- Flunisolide
- Fluocinolone
- Fluocinonide
- Fluocortin
- Fluocortolone
- Fluorometholone
- Flurandrenolide
- Fluticasone
- Halcinonide
- Halobetasol
- Hydrocortisone
- Loteprednol
- Medrysone
- Methylprednisolone
- Mometasone
- Paramethasone
- Prednicarbate
- Prednisolone
- Prednisone
- Rimexolone
- Triamcinolone
- Vincristine
- Vincristine Sulfate Liposome
How much does Leukine (sargramostim) cost?
$2,120.55
Leukine (sargramostim) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Leukine (sargramostim) will not be safe for you to take.
- Allergy to yeast-derived products or other granulocyte-macrophage colony-stimulating factor (GM-CSF) products
What are alternatives to Leukine (sargramostim) ?
Prevention of low neutrophil-related complications in:
Preparation for blood collection for your own stem cell transplant (Neupogen, Nivestym, and Zarxio only)
Increase survival in people exposed to bone marrow-suppressing radiation (Neupogen only)