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Decrease in arterial oxygen partial pressure within the first 24 h of rhGM-CSF administration in AML patients

M Zühlsdorf1, M von Eiff, M Thomas

  • 1Department of Haematology and Oncology, University of Münster, Germany.

European Journal of Haematology
|January 1, 1998
PubMed
Summary
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Granulocyte-macrophage colony-stimulating factor (GM-CSF) in AML patients did not cause oxygen desaturation. However, it led to mild, clinically insignificant decreases in blood oxygen tension due to ventilation/perfusion mismatches.

Area of Science:

  • Hematology
  • Pulmonology
  • Pharmacology

Background:

  • Granulocyte-macrophage colony-stimulating factor (GM-CSF) can cause pulmonary complications, including dyspnea and decreased oxygen saturation, particularly with high-dose intravenous administration.
  • The "first dose effect" is a known concern with GM-CSF, necessitating investigation into its pulmonary impact in specific patient populations.

Purpose of the Study:

  • To investigate potential pulmonary disturbances in adult de novo acute myeloid leukemia (AML) patients receiving yeast-derived recombinant human GM-CSF (rhGM-CSF) before chemotherapy.
  • To assess the safety and pulmonary effects of rhGM-CSF, specifically looking for the "first dose effect" and changes in oxygenation and lung function.

Main Methods:

  • Eighteen adult de novo AML patients were monitored over 22 treatment episodes.

Related Experiment Videos

  • rhGM-CSF was administered subcutaneously or intravenously at 250 micrograms/m2/d, 24 hours prior to chemotherapy.
  • Pulmonary function tests (spirometry, bodyplethysmography, DLCO) and arterial blood gas analyses were performed before and after GM-CSF administration. Continuous pulse oximetry monitored oxygen saturation.

    • Main Results:

    • Continuous oxygen saturation monitoring did not reveal any "first dose effect."
    • Mean partial pressure of oxygen (PaO2) decreased significantly from 78.9 mmHg to 72.8 mmHg after 24 hours of GM-CSF (p < 0.01).
    • These PaO2 shifts were mainly observed in patients with pre-existing low PaO2 and were independent of administration route, age, or leukocyte count. No dyspnea was reported, and DLCO did not significantly decrease.

    Conclusions:

    • Contemporary dosing of yeast-derived rhGM-CSF in AML patients avoids short-term oxygen desaturation.
    • The observed mild impairment in oxygen tension is clinically benign and attributed to ventilation/perfusion mismatches.
    • Clinicians should consider this effect in patients with initially subnormal PaO2 levels.