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Bone marrow stimulation with G-CSF for lymphoma

General

G-CSF (granulocyte colony-stimulating factor) is a hematopoetic growth factor. Human G-CSF is a glycoprotein which regulates production and liberation of neutrophile granulocytes from bone marrow.  

For bone marrow stimulation with G-CSF, the drugs Neupogen® and Neulasta® are injected subcutaneously. Neulasta® and Neupogen® are available in prefilled syringes. Neupogen® is given once daily during aplasia. Neulasta® has a protracted effect and is given only one day after chemotherapy (i.e. day 2-4).

The patients may administer the injection themselves at home if they are instructed and comfortable doing so.  

 

Indications

  • Mobilization of stem cells to peripheral blood for autologous stem cell harvesting, usually a dosage of 10 µg/kg/day.
  • For high-dose chemotherapy with autologous stem cell support (HMAS), where bone marrow is used as the stem cell source. 
  • Primary prophylaxis to maintain dose intensity for curative chemotherapy with documentation that this is not possible without G-CSF (for example CHO(E)P-14, dose-escalated BEACOPP).
  • Secondary prophylaxis for curative chemotherapy where the patient after previous chemotherapy developed neutropenic fever. 
  • Secondary prophylaxis to maintain dose intensity for curative chemotherapy where experience has shown that the patient developed neutropenia that would have led to neutropenia leading to dose reduction or postponement of therapy (for example CHOP-21, ABVD, standard BEACOPP)
  • Lasting neutropenic fever in a critically ill patient, for example serious pneumonia, hypotension, serious sepsis, or fungal infection. 

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