{"entity":{"id":"g-csf-growth-factors","kind":"technology","name":"Growth factors: G-CSF and febrile neutropenia prevention","aka":[],"tldr":"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.","status":"standard-of-care","asOf":"2026-09-08","wikipedia":"https://en.wikipedia.org/wiki/Filgrastim","links":[{"label":"ASCO WBC growth factors guideline 2015","url":"https://doi.org/10.1200/JCO.2015.62.3488"},{"label":"MASCC febrile neutropenia risk index","url":"https://mascc.org/resources/mascc-risk-index-score/"}],"tags":["gap-fill","supportive"],"related":[],"cancers":[],"sections":["supportive-care"],"technologies":["cytotoxic-chemotherapy","autologous-stem-cell-transplant","transfusion-support"],"targets":[],"drugs":["efbemalenograstim-alfa","lipegfilgrastim"],"companies":["eurofarma"],"institutions":[],"pathways":[],"terms":["biosimilar"],"trials":[],"people":[],"bottlenecks":[],"keyPapers":["paper-smith-j-clin-oncol"],"journals":[],"dependsOn":[],"notes":[],"principle":"Recombinant granulocyte colony-stimulating factor accelerates neutrophil precursor proliferation and release, shortening the neutropenic nadir after myelosuppressive chemotherapy.","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"],"since":1991},"route":"/technologies/g-csf-growth-factors/","neighbours":{"section":[{"id":"supportive-care","kind":"section","name":"Supportive Care & Survivorship","route":"/fronts/supportive-care/"}],"technology":[{"id":"autologous-stem-cell-transplant","kind":"technology","name":"Autologous stem cell transplant (high-dose therapy)","route":"/technologies/autologous-stem-cell-transplant/"},{"id":"cytotoxic-chemotherapy","kind":"technology","name":"Cytotoxic chemotherapy","route":"/technologies/cytotoxic-chemotherapy/"},{"id":"norton-simon-hypothesis","kind":"technology","name":"Norton-Simon hypothesis and dose-dense chemotherapy","route":"/technologies/norton-simon-hypothesis/"},{"id":"transfusion-support","kind":"technology","name":"Transfusion support and anaemia management","route":"/technologies/transfusion-support/"}],"drug":[{"id":"efbemalenograstim-alfa","kind":"drug","name":"Efbemalenograstim alfa","route":"/drugs/efbemalenograstim-alfa/"},{"id":"filgrastim","kind":"drug","name":"Filgrastim (G-CSF)","route":"/drugs/filgrastim/"},{"id":"lipegfilgrastim","kind":"drug","name":"Lipegfilgrastim","route":"/drugs/lipegfilgrastim/"},{"id":"pegfilgrastim","kind":"drug","name":"Pegfilgrastim","route":"/drugs/pegfilgrastim/"}],"company":[{"id":"eurofarma","kind":"company","name":"Eurofarma","route":"/companies/eurofarma/"},{"id":"viatris","kind":"company","name":"Viatris","route":"/companies/viatris/"}],"term":[{"id":"biosimilar","kind":"term","name":"Biosimilar","route":"/terms/biosimilar/"},{"id":"dose-dense-chemotherapy","kind":"term","name":"Dose-dense and metronomic chemotherapy","route":"/terms/dose-dense-chemotherapy/"},{"id":"febrile-neutropenia","kind":"term","name":"Febrile neutropenia","route":"/terms/febrile-neutropenia/"},{"id":"lymphoma-tx-pjp-and-infection-prophylaxis","kind":"term","name":"Infection prophylaxis in lymphoma: PJP, herpes, fungal risk and vaccination","route":"/terms/lymphoma-tx-pjp-and-infection-prophylaxis/"},{"id":"neutropenia","kind":"term","name":"Neutropenia","route":"/terms/neutropenia/"}],"paper":[{"id":"paper-smith-j-clin-oncol","kind":"paper","name":"Recommendations for the Use of WBC Growth Factors: American Society of Clinical Oncology Clinical Practice Guideline Update","route":"/key-papers/paper-smith-j-clin-oncol/"}],"cancer":[{"id":"advanced-stage-classical-hodgkin-lymphoma","kind":"cancer","name":"Advanced-stage classical Hodgkin lymphoma (stage III to IV)","route":"/cancers/advanced-stage-classical-hodgkin-lymphoma/"},{"id":"dlbcl","kind":"cancer","name":"Diffuse large B-cell lymphoma","route":"/cancers/dlbcl/"},{"id":"hiv-associated-lymphoma","kind":"cancer","name":"HIV-associated (AIDS-related) lymphomas","route":"/cancers/hiv-associated-lymphoma/"},{"id":"leukaemia","kind":"cancer","name":"Leukaemia (all types)","route":"/cancers/leukaemia/"},{"id":"mds-lower-risk","kind":"cancer","name":"Lower-risk myelodysplastic syndromes","route":"/cancers/mds-lower-risk/"},{"id":"mds","kind":"cancer","name":"Myelodysplastic syndromes / neoplasms (MDS)","route":"/cancers/mds/"},{"id":"peripheral-t-cell-lymphoma","kind":"cancer","name":"Peripheral T-cell lymphomas (including cutaneous T-cell lymphoma)","route":"/cancers/peripheral-t-cell-lymphoma/"}],"institution":[{"id":"wehi","kind":"institution","name":"Walter and Eliza Hall Institute of Medical Research","route":"/institutions/wehi/"}],"roadmap":[{"id":"chemotherapy-roadmap","kind":"roadmap","name":"Chemotherapy roadmap: mustard gas → curative combinations → the warhead inside smarter drugs","route":"/roadmaps/chemotherapy-roadmap/"},{"id":"survivorship-roadmap","kind":"roadmap","name":"Supportive care and survivorship roadmap: making treatment bearable → proving it extends life → caring for tens of millions afterwards","route":"/roadmaps/survivorship-roadmap/"}],"trial":[{"id":"nct03246529","kind":"trial","name":"A Phase III, Safety, Tolerability and Efficacy of Combination Treatment of BL-8040 and Granulocyte Colony Stimulating Factor (G-CSF) as Compared to Pl","route":"/trials/nct03246529/"},{"id":"nct06690775","kind":"trial","name":"CATALINA-2: A Clinical Study of TORL-1-23 in Platinum-resistant Ovarian Cancer.","route":"/trials/nct06690775/"}]}}