# G-CSF prophylaxis by febrile neutropenia risk

Source: https://onco.cc/protocols/g-csf-prophylaxis-by-febrile-neutropenia-risk/  
OnCo record `g-csf-prophylaxis-by-febrile-neutropenia-risk` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Some chemotherapy lowers the white cells that fight infection so much that a fever becomes dangerous. If your treatment carries a high risk of this, or you had an infection with low white cells on an earlier cycle, you may be given injections of a growth factor (G-CSF) after each cycle to help your white cells recover faster.

## Summary

Primary prophylaxis with G-CSF is warranted when the regimen's risk of febrile neutropenia is about 20 per cent or higher and no equally effective and safe regimen without it exists (ASCO 2015; EORTC 2010 likewise for regimens at high risk, 20 per cent or more). For regimens with a risk of 10 to 20 per cent, patient factors such as age 65 or over decide (EORTC), and ASCO recommends prophylaxis for those at high risk from age, medical history, disease and the myelotoxicity of the regimen. After an episode of febrile neutropenia, G-CSF should be given in later cycles (secondary prophylaxis, EORTC). G-CSF is also used where it is part of a dose-dense or dose-intense regimen with proven benefit, or to keep dose intensity where cutting the dose worsens the outlook.

NICE CG151 frames the same rule from the other side: do not routinely offer G-CSF to prevent neutropenic sepsis unless it is an integral part of the regimen or needed to maintain dose intensity. Filgrastim (including biosimilars), lenograstim and pegfilgrastim are all effective (EORTC); pegfilgrastim is given once per cycle, which may avoid the short courses of daily injections seen in audits. ASCO advises dose-dense regimens needing G-CSF only in trials or where efficacy data are convincing. The AGIHO 2026 update confirms most of its 2014 recommendations and adds guidance for immunotherapy settings.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: primary G-CSF prophylaxis; secondary G-CSF prophylaxis; pegfilgrastim after chemotherapy; filgrastim injections; white cell growth factor injections
- Tags: protocol; neutropenia; supportive-care

## Connected records

- protocols: [Suspected febrile neutropenia (neutropenic sepsis): the first hour](https://onco.cc/protocols/febrile-neutropenia-first-hour/)
- fronts: [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- technologies: [Growth factors: G-CSF and febrile neutropenia prevention](https://onco.cc/technologies/g-csf-growth-factors/)
- drugs: [Filgrastim (G-CSF)](https://onco.cc/drugs/filgrastim/), [Lenograstim](https://onco.cc/drugs/lenograstim/), [Pegfilgrastim](https://onco.cc/drugs/pegfilgrastim/)
- institutions: [American Society of Clinical Oncology (ASCO)](https://onco.cc/institutions/asco/), [National Institute for Health and Care Excellence](https://onco.cc/institutions/nice/)
- terms: [Febrile neutropenia](https://onco.cc/terms/febrile-neutropenia/), [Neutropenia](https://onco.cc/terms/neutropenia/)

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