# Growth factors: G-CSF and febrile neutropenia prevention

Source: https://onco.cc/technologies/g-csf-growth-factors/  
OnCo record `g-csf-growth-factors` (Technology). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Injections of filgrastim or its long-acting form pegfilgrastim after chemotherapy make white cells recover faster, cutting the risk of life-threatening infections and allowing chemotherapy on schedule.

## Summary

Filgrastim (1991) and pegfilgrastim (2002) reduce febrile neutropenia incidence by ~50% and infection-related mortality; guidelines (ASCO, EORTC, NCCN) recommend primary prophylaxis when regimen risk of febrile neutropenia is >20% or 10-20% with patient risk factors, and secondary prophylaxis after an episode. Biosimilars (since 2015 in the US) cut cost; on-body injectors and same-day dosing trials address logistics. Efbemalenograstim and eflapegrastim (2022) are newer long-acting forms; trilaciclib (CDK4/6 inhibitor, 2021) protects marrow in SCLC; plinabulin failed. Febrile neutropenia itself is managed by risk score (MASCC, CISNE) with outpatient oral antibiotics for low risk. G-CSF also mobilises stem cells (with plerixafor) and is contraindicated during concurrent chemoradiation to the chest.

## Fields

- Kind: Technology
- Status: standard-of-care
- Last checked: 2026-09-08
- Tags: gap-fill; supportive
- Principle: Recombinant granulocyte colony-stimulating factor accelerates neutrophil precursor proliferation and release, shortening the neutropenic nadir after myelosuppressive chemotherapy.
- Since: 1991
- Strengths: Halves febrile neutropenia; maintains dose intensity; Biosimilars widely available; Enables dose-dense regimens (e.g. every-2-week AC-T)
- Limitations: Bone pain in ~30%; Cost drove over- and under-use; Rare splenic rupture; theoretical MDS/AML risk debated

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Filgrastim
- ASCO WBC growth factors guideline 2015: https://doi.org/10.1200/JCO.2015.62.3488
- MASCC febrile neutropenia risk index: https://mascc.org/resources/mascc-risk-index-score/

## Connected records

- fronts: [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- technologies: [Autologous stem cell transplant (high-dose therapy)](https://onco.cc/technologies/autologous-stem-cell-transplant/), [Cytotoxic chemotherapy](https://onco.cc/technologies/cytotoxic-chemotherapy/), [Norton-Simon hypothesis and dose-dense chemotherapy](https://onco.cc/technologies/norton-simon-hypothesis/), [Transfusion support and anaemia management](https://onco.cc/technologies/transfusion-support/)
- drugs: [Efbemalenograstim alfa](https://onco.cc/drugs/efbemalenograstim-alfa/), [Filgrastim (G-CSF)](https://onco.cc/drugs/filgrastim/), [Lipegfilgrastim](https://onco.cc/drugs/lipegfilgrastim/), [Pegfilgrastim](https://onco.cc/drugs/pegfilgrastim/)
- companies: [Eurofarma](https://onco.cc/companies/eurofarma/), [Viatris](https://onco.cc/companies/viatris/)
- terms: [Biosimilar](https://onco.cc/terms/biosimilar/), [Dose-dense and metronomic chemotherapy](https://onco.cc/terms/dose-dense-chemotherapy/), [Febrile neutropenia](https://onco.cc/terms/febrile-neutropenia/), [Infection prophylaxis in lymphoma: PJP, herpes, fungal risk and vaccination](https://onco.cc/terms/lymphoma-tx-pjp-and-infection-prophylaxis/), [Neutropenia](https://onco.cc/terms/neutropenia/)
- key papers: [Recommendations for the Use of WBC Growth Factors: American Society of Clinical Oncology Clinical Practice Guideline Update](https://onco.cc/key-papers/paper-smith-j-clin-oncol/)
- cancers: [Advanced-stage classical Hodgkin lymphoma (stage III to IV)](https://onco.cc/cancers/advanced-stage-classical-hodgkin-lymphoma/), [Diffuse large B-cell lymphoma](https://onco.cc/cancers/dlbcl/), [HIV-associated (AIDS-related) lymphomas](https://onco.cc/cancers/hiv-associated-lymphoma/), [Leukaemia (all types)](https://onco.cc/cancers/leukaemia/), [Lower-risk myelodysplastic syndromes](https://onco.cc/cancers/mds-lower-risk/), [Myelodysplastic syndromes / neoplasms (MDS)](https://onco.cc/cancers/mds/), [Peripheral T-cell lymphomas (including cutaneous T-cell lymphoma)](https://onco.cc/cancers/peripheral-t-cell-lymphoma/)
- institutions: [Walter and Eliza Hall Institute of Medical Research](https://onco.cc/institutions/wehi/)
- roadmaps: [Chemotherapy roadmap: mustard gas → curative combinations → the warhead inside smarter drugs](https://onco.cc/roadmaps/chemotherapy-roadmap/), [Supportive care and survivorship roadmap: making treatment bearable → proving it extends life → caring for tens of millions afterwards](https://onco.cc/roadmaps/survivorship-roadmap/)
- trials: [A Phase III, Safety, Tolerability and Efficacy of Combination Treatment of BL-8040 and Granulocyte Colony Stimulating Factor (G-CSF) as Compared to Pl](https://onco.cc/trials/nct03246529/), [CATALINA-2: A Clinical Study of TORL-1-23 in Platinum-resistant Ovarian Cancer.](https://onco.cc/trials/nct06690775/)

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