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Granulocyte-macrophage colony-stimulating factor (GM-CSF) decreases left ventricular function. An echocardiographic
S Knoops1, A B Groeneveld, O Kamp
1Medical Intensive Care Unit, Free University Hospital Amsterdam, The Netherlands.
Insights
Granulocyte-macrophage colony-stimulating factor (GM-CSF) can cause a temporary, slight decrease in left ventricular (LV) contractility, impacting ejection fraction (EF) and cardiac output (CO) during chemotherapy.
Area of Science:
- Cardiology
- Oncology
- Pharmacology
Background:
- Chemotherapy, particularly doxorubicin, can negatively affect cardiac function.
- Granulocyte-macrophage colony-stimulating factor (GM-CSF) is used to mitigate chemotherapy-induced neutropenia.
- The cardiac effects of GM-CSF during chemotherapy are not fully understood.
Purpose of the Study:
- To investigate the impact of GM-CSF on cardiac function in patients undergoing chemotherapy.
- To assess changes in left ventricular dimensions, ejection fraction, and cardiac output during GM-CSF administration.
Main Methods:
- Echocardiographic assessments were performed on patients with advanced sarcoma and breast cancer.
- Cardiac function was evaluated before, during, and after chemotherapy courses, with and without GM-CSF.
- Measurements included left ventricular end-systolic diameter (LVESD), ejection fraction (EF), and cardiac output (CO).
Main Results:
- GM-CSF administration was associated with a transient, statistically significant increase in LVESD (median 6%) compared to chemotherapy alone.
- Cardiac output (CO) and ejection fraction (EF) showed a tendency to decrease during GM-CSF treatment.
- These findings indicate a small, temporary reduction in left ventricular contractility.
Conclusions:
- GM-CSF may induce a transient, mild impairment of left ventricular contractility.
- Further research is needed to fully elucidate the cardiovascular safety profile of GM-CSF in cancer patients.
- Cardiologists and oncologists should consider these potential cardiac effects when using GM-CSF.
Abstract:
To study the effect of granulocyte-macrophage colony-stimulating factor (GM-CSF) on the heart, echocardiographic assessments of left ventricular (LV) end-diastolic and end-systolic (ES) diameters (D), ejection fraction (EF) and cardiac output (CO) were done in six male patients (28-70 years of age) with advanced sarcoma (Group 1), prior to (day -1-0), during (day 7-9) and after (day 20-21) a first course of i.v. doxorubicin (day 0) without GM-CSF and a second course (3 weeks after the first one) with GM-CSF 250 microg/m(2)subcutaneously and daily from day 1-11. A similar study was done in ten female patients with advanced breast cancer (31-58 years of age, Group 2) for a first course of doxorubicin+cyclophosphamide with GM-CSF (same schedule as in Group 1). As compared to the mean of values prior to and after the course with GM-CSF in Group 1 and 2, the LVESD during GM-CSF administration transiently increased by median 6% (range -19 to 30%, P<0.05) vs -9% (-21 to 6%, not significant) in the first course without GM-CSF in Group 1 (P<0.05 between courses). The CO and EF tended to decrease during GM-CSF. GM-CSF thus causes a small and transient decrease of LV contractility.