The effect of granulocyte—macrophage colony‐stimulating factor (GM‐CSF) on hepatitis B vaccination in haemodialysis patients

Haemodialysis patients often fail to respond to hepatitis B vaccination. In this pilot study, 15 patients previously non-responsive to at least three 40 micrograms doses of hepatitis B vaccine were given 0.5, 5 or 10 micrograms kg-1 granulocyte-macrophage colony-stimulating factor (GM-CSF) subcutaneously 24 h prior to booster vaccination with a hepatitis B vaccine. Seven of the 15 patients developed antibody to hepatitis B surface antigen (HBsAb) (35-7240 IU L-1) upon initial vaccination with GM-CSF and two of four individuals responded with low HBsAb titres of 15 and 60 IU L-1 when revaccinated with hepatitis B surface antigen (HBsAg) and twice the dose of GM-CSF. The application of GM-CSF was associated with adverse effects that were, in general, mild to moderate in severity and appeared to be dose dependent. Two patients, both receiving 10 micrograms kg-1 GM-CSF discontinued the study because of severe hypotension.