Treatment with granulocyte-colony stimulating factors
should only be prescribed by those experienced in their use.
Neonatal neutropenia
Filgrastim has been used to treat sepsis-induced neutropenia
in preterm neonates. There is no clear evidence that
granulocyte–colony stimulating factors improve survival or
long–term outcomes.
IMMUNOSTIMULANTS›GRANULOCYTE-COLONY
STIMULATING FACTORS
Granulocyte-colony stimulating f
factors
lDRUG ACTIONRecombinant human granulocyte-colony
stimulating factor (rhG-CSF) stimulates the production of
neutrophils.
lCAUTIONSMalignant myeloid conditions.pre-malignant
myeloid conditions.risk of splenomegaly and rupture—
spleen size should be monitored.sickle-cell disease
CAUTIONS, FURTHER INFORMATION
▶Acute respiratory distress syndromeThere have been reports
of pulmonary infiltrates leading to acute respiratory
distress syndrome—patients with a recent history of
pulmonary infiltrates or pneumonia may be at higher risk.
lSIDE-EFFECTS
▶Common or very commonArthralgia.cutaneous vasculitis.
dyspnoea.haemoptysis.headache.hypersensitivity.
leucocytosis.pain.spleen abnormalities.
thrombocytopenia
▶UncommonAcute febrile neutrophilic dermatosis.
capillary leak syndrome.hypoxia.pulmonary oedema.
respiratory disorders.sickle cell anaemia with crisis
SIDE-EFFECTS, FURTHER INFORMATIONTreatment should
be withdrawn in patients who develop signs of pulmonary
infiltration.
lPREGNANCYThere have been reports of toxicity inanimal
studies and manufacturers advise not to use granulocyte-
colony stimulating factors during pregnancy unless the
potential benefit outweighs the risk.
lBREAST FEEDINGThere is no evidence for the use of
granulocyte-colony stimulating factors during breast-
feeding and manufacturers advise avoiding their use.
lMONITORING REQUIREMENTS
▶Full blood counts including differential white cell and
platelet counts should be monitored.
▶Spleen size should be monitored during treatment—risk of
splenomegaly and rupture.
eiiiiFabove
Filgrastim
(Recombinant human granulocyte-colony
stimulating factor; G-CSF)lINDICATIONS AND DOSE
Reduction in duration of neutropenia and incidence of
febrile neutropenia in cytotoxic chemotherapy for
malignancy (except chronic myeloid leukaemia and
myelodysplastic syndromes) (specialist use only)
▶BY SUBCUTANEOUS INJECTION, OR BY INTRAVENOUS INFUSION
▶Child: 5 micrograms/kg daily until neutrophil count in
normal range, usually for up to 14 days (up to 38 days
in acute myeloid leukaemia), to be started at least
24 hours after cytotoxic chemotherapy. Preferably
given by subcutaneous injection; if given by
intravenous infusion, administer over 30 minutesReduction in duration of neutropenia (and associated
sequelae) in myeloablative therapy followed by bone-
marrow transplantation (specialist use only)
▶BY SUBCUTANEOUS INFUSION, OR BY INTRAVENOUS INFUSION
▶Child: 10 micrograms/kg daily, to be started at least
24 hours following cytotoxic chemotherapy and within
24 hours of bone-marrow infusion, then adjusted
according to neutrophil count—consult product
literature, doses administered over 30 minutes or
24 hours via intravenous route and over 24 hours via
subcutaneous route
Mobilisation of peripheral blood progenitor cells for
autologous infusion, used alone (specialist use only)
▶BY SUBCUTANEOUS INFUSION, OR BY SUBCUTANEOUS
INJECTION
▶Child: 10 micrograms/kg daily for 5 – 7 days, to be
administered over 24 hours if given by subcutaneous
infusion
Mobilisation of peripheral blood progenitor cells for
autologous infusion, used following adjunctive
myelosuppressive chemotherapy—to improve yield
(specialist use only)
▶BY SUBCUTANEOUS INJECTION
▶Child: 5 micrograms/kg daily until neutrophil count in
normal range, to be started the day after completing
chemotherapy, for timing of leucopheresis, consult
product literature
Mobilisation of peripheral blood progenitor cells in
normal donors for allogeneic infusion (specialist use
only)
▶BY SUBCUTANEOUS INJECTION
▶Child 16–17 years: 10 micrograms/kg daily for 4 – 5 days,
for timing of leucopheresis, consult product literature
Severe congenital neutropenia and history of severe or
recurrent infections (distinguish carefully from other
haematological disorders) (specialist use only)
▶BY SUBCUTANEOUS INJECTION
▶Child:Initially 12 micrograms/kg daily, adjusted
according to response, can be given in single or divided
doses, consult product literature and local protocol
Severe cyclic neutropenia, or idiopathic neutropenia and
history of severe or recurrent infections (distinguish
carefully from other haematological disorders)
(specialist use only)
▶BY SUBCUTANEOUS INJECTION
▶Child:Initially 5 micrograms/kg daily, adjusted
according to response, can be given in single or divided
doses, consult product literature and local protocol
Persistent neutropenia in HIV infection (specialist use
only)
▶BY SUBCUTANEOUS INJECTION
▶Child:Initially 1 microgram/kg daily, subsequent doses
increased as necessary until neutrophil count in
normal range, then adjusted to maintain neutrophil
count in normal range—consult product literature;
maximum 4 micrograms/kg per day
Neonatal neutropenia (specialist use only)
▶BY SUBCUTANEOUS INJECTION
▶Neonate: 10 micrograms/kg daily, to be discontinued if
white cell count exceeds 50 x 109 /litre.Glycogen storage disease type 1 b (specialist use only)
▶BY SUBCUTANEOUS INJECTION
▶Child:Initially 5 micrograms/kg daily, dose to be
adjusted as necessarylUNLICENSED USENot licensed for treatment of glycogen
storage disease or neonatal neutropenia.
lCONTRA-INDICATIONSSevere congenital neutropenia
(Kostmann’s syndrome) with abnormal cytogeneticsBNFC 2018 – 2019 Neutropenia 579
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