Leucomax (Molgramostim)

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Your doctor has recommended a treatment called Leucomax (Molgramostim) which is used to support you and your white cells during chemotherapy. This page aims to support the information given to you by the clinic to help you understand why neupogen is given and what to expect. It also gives information to the district nurse who may be giving you the injections. For more detailed information please refer to the product information within the packet.

What are white cells?   Blood contains three main elements. The red cells which carry oxygen around the body from the lungs, Platelets which stop us bleeding when we are cut, the white cells help our immunity and protect us from infection. There are a number of different types of white cells but one of the most important types, are called granulocytes. These protect us from bacteria which are the most likely source of infection during chemotherapy.

How does chemotherapy effect your white cells? Chemotherapy affects the rapidly dividing cells within the body.  The cells which make white cells are found within the bone marrow, called "stem cells", also grow fairly rapidly and hence are often damaged by chemotherapy (see chemotherapy).  Hopefully the most rapidly dividing cells of all are those within the tumour. This is one of the reasons chemotherapy is given in cycles which allows the whites cells to recover before the next injection. Hopefully less normal cells are killed at each cycle than tumour cells and more normal cells recover than tumour cells before the next cycle . Sometimes too many white cells are killed and patients become susceptible to infection which tend to be more serious. This is most likely to happen in the middle week between cycles. If during chemotherapy you experience shivering or shaking attacks of fever or feel hot or unwell check your temperature.  If it is raised telephone the Hospital immediately and they will advise you. Do not take Paracetamol or Aspirin as this will bring your temperature down and mask the signs of infection. 

How does Leucomax work?   Leucomax contains a chemical  which stimulates the colonies of white stem cells within the bone marrow  causing the level of granulocytes in the blood to rise.   Increasing the levels granulocytes in the blood stream reduced the risk and severity of infection. In the same way chemotherapy affects the rapidly dividing white cells it can also affect the platelets. The cells which make platelets are also found within the bone marrow, called "platelet stem cells - megacaryocytes". Leucomax also stimulates megacaryocytes and increases the number of platelets into the blood stream thereby reducing the risk of bleeding.   (Granulocyte & Megacaryocyte stimulating factor - GM-CSF)

When is Leucomax used? Leucomax is not often used  at the start of the first cycle of chemotherapy as in most cases it is not necessary (primary prophylaxis). The exception is "high dose" chemotherapy (see autologous bone marrow transplantation) when it is used to raise the level of stem cells in the blood - these can be harvested and used stored in a fridge - after the chemotherapy they can be re-injected into the patient. Sometimes during conventional chemotherapy too many white cells are killed and the patient develops an infection which can be serious, sometimes neupogen is used as well as antibiotics to treat the infection. At other times the white cells have not recovered by the time the next chemotherapy is due. Your oncologist has a choice to delay the chemotherapy and/or reduce the dose and/or give neupogen. Giving Leucomax in this situation has been shown to allow a higher dose of chemotherapy to be given (secondary prophylaxis). Whether this improves the outcome of the chemotherapy is the under debate and is the subject of ongoing trials.

How should Leucomax be given?  Leucomax is given as a small injection under the skin (subcutaneous injection) containing 60 units/kg of Molgramostim. The ways it is given vary from doctor to doctor and department to department. The most usual way is immediately following the chemotherapy every day for 7 days but this can vary from 3-10 (You may wish to write the days in the table below and show it to the district nurse). Some patients learn to inject themselves (see self injection) but in others your chemotherapy nurse will arrange a district nurse to give it.

Side effects

Leucomax is generally well tolerated and is often difficult to separate the mild side effects from those caused by the chemotherapy. Even so, occasional side effects can occur and these are mentioned below.  It is rarely possible to develop side effects not mentioned here.

• It is common to have aching bones and joints for 2-3 days starting 1-2 days after the start of the injections. This is usually mild and is caused by the bone marrow working harder to More white cells. Occasionally it is more troublesome and pain killers are required. (Provided you don't have a temperature paracetamol is often helpful, it is not strong enough ask your doctor about anti-inflammatory drugs. Remember if you feel unwell check your temperature before you due to take your next tablet).
• Occasionally irritation at the injection site ( remember to alternate the sites each day).
• Very rarely a disturbance in the liver function blood tests.
• Rarely - Mild flu like symptom,  headache, malaise, rigors & nausea.
• Rarely - Mild itching and occasional skin rash.

These last two symptoms are caused by a mild allergic reaction. They can usually be corrected next time by a small dose of oral steroids can be given with the Leucomax.

Further general information Your doctors and specialist nurses are in an ideal position to give you relevant information on your disease and treatment as they know your individual circumstances. Cancerbackup has a help line (0808 800 1234) and a prize winning video available in English, Italian, Urdu, Bengali, Gujarati & Hindi explaining Radiotherapy & Chemotherapy. Cancernet.co.uk has over 500 pages describing cancer, its management, practical tips and tool which patients, their carers and their doctors have found helpful during the cancer journey.