II. Indications
- Myelosuppressive Chemotherapy-Induced Neutropenia
- Bone Marrow Transplant
- Peripheral blood progenitor cell collection (donor)
- Severe chronic congenital Neutropenia (or other chronic Neutropenia)
- Acute Radiation Syndrome related myelosuppression
III. Mechanism
- Granulocyte Colony-Stimulating Factor (G-CSF)
- Endogenous Cytokine that modulates the production, differentiation and function Neutrophilic Granulocyte progenitors
- G-CSF is endogenously produced by Monocytes, fibroblasts, and endothelial cells
- G-CSF activates Granulocyte production via binding specific cell surface receptors
- Filgrastim
- Recombinant, synthetic agent that is nearly identical to the B isoform of G-CSF
- Like G-CSF, Filgrastim stimulates the production of Neutrophils
- Used to counter Neutropenia secondary to anticancer drug induced myelosuppression
IV. Precautions
- Do NOT give within 24 hours of cytotoxic/myelosuppressive Chemotherapy
- Unknown risk of cytotoxic agents on rapidly dividing myeloid cells
- Storage
- Store medication in refrigerator
- Use within 24 hours when at room Temperature
V. Dosing: Adults and Children
- See other references for specific dosing
- Myelosuppressive Chemotherapy-Induced Neutropenia
- Start 5 mcg/kg/day SQ or IV until postnadir ANC>10,000/mm3 (or otherwise considered recovered)
-
Bone Marrow Transplant
- Start 10 mcg/kg/day IV infused over 4 to 24 hours, given >24 hours after cytotoxic Chemotherapy or marrow
- Peripheral blood progenitor cell collection (donor)
- Give 10 mcg/kg/day SQ for at least 4 days (up to 6 to 7 days) before first leukapheresis and until final leukapheresis
- Decrease dose if White Blood Cell Count >100,000/mm3
- Severe chronic congenital Neutropenia (or other chronic Neutropenia)
- Start 5 mcg/kg SQ daily
- Some protocols start 6 mcg/kg SQ twice daily
-
Acute Radiation Syndrome related myelosuppression
- Start 10 mcg/kg SQ daily
VI. Adverse Effects
- Medullary bone pain
- Allergic Reaction
- Cutaneous Vasculitis
VII. Safety
- Unknown safety in pregnancy
- Unknown safety in Lactation