G-CSF / filgrastim
Formal Definition
Granulocyte Colony-Stimulating Factor (G-CSF); a cytokine (endogenous or recombinant as filgrastim/pegfilgrastim) that stimulates the bone marrow to produce and release neutrophils; used therapeutically to shorten the duration of neutropenia following chemotherapy, in stem cell mobilization, in febrile neutropenia, and in congenital or acquired neutropenic states.
How It's Used on the Ward
"Neupogen" (filgrastim) or "Neulasta" (pegfilgrastim) or just "growth factor" or "G-CSF" — the shots that bring the white count back up after chemo knocks it down.
Example
""ANC nadir of 120 on day 10 post-CHOP with neutropenic fever: filgrastim 5 mcg/kg SC daily started to accelerate neutrophil recovery. Expected ANC recovery in 5–7 days with G-CSF vs 10–14 days without.""
Clinical Context
Pegfilgrastim (Neulasta) is the long-acting formulation given once per cycle 24–48h after chemo (on-body injector device). Filgrastim (Neupogen) is short-acting, given daily until ANC recovery. Indications: secondary prophylaxis after prior febrile neutropenia episode, primary prophylaxis in high-risk regimens (>20% febrile neutropenia risk), treatment of febrile neutropenia, stem cell mobilization for transplant harvest. Side effects: bone pain (marrow expansion — treat with NSAIDs/loratadine), splenomegaly, rare splenic rupture. Do NOT give within 24 hours before or after chemotherapy (kills dividing progenitors). Bone pain is so common it has become expected — warn patients before each cycle.
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