Granulocyte colony stimulating factor (G-CSF)

G-CSF is a type of growth factor. Growth factors are proteins made in the body and some of them make the bone marrow produce blood cells. The full name for G-CSF is granulocyte colony stimulating factor.

There are different types, including

• Lenograstim (Granocyte)
• Filgrastim (Neupogen, Zarzio, Nivestim, Ratiograstim)
• Long acting (pegylated) filgrastim (pegfilgrastim, Neulasta)

Pegylated G-CSF stays in the body for longer so you have treatment less often than with the other types of G-CSF.

G-CSF is made artificially and used as a treatment to stimulate the body to make more white blood cells. You may have G-CSF

• After chemotherapy
• Before and after a stem cell transplant

G-CSF after chemotherapy

A common side effect of chemotherapy is a drop in the number of blood cells, which leads to an increased risk of getting an infection. Most people’s white blood cells recover quickly after chemotherapy and they don’t need treatment with G-CSF. But with some types of chemotherapy, such as high dose treatment, it can take a long time for the number of white blood cells to rise again.

Having G-CSF treatment can make white blood cell levels go up faster. So if your white blood cell count doesn’t go up as it should you may have G-CSF treatment. With some types of chemotherapy you have G-CSF as a standard part of your treatment plan.

G-CSF before and after a stem cell transplant

You may have G-CSF as part of a stem cell transplant. Before the treatment you have G-CSF to stimulate the bone marrow to produce stem cells and release them into the blood. The stem cells are collected and then you have high dose chemotherapy.

The chemotherapy stops your bone marrow producing white blood cells. So you have the stem cells back into your bloodstream. They go into the bone marrow and start making white blood cells again.

You can have G-CSF either

• As an injection just under your skin (subcutaneously)
• As a drip into your bloodstream

G-CSF as an injection under the skin 

Most people have G-CSF as an injection just under their skin (subcutaneously). You have this daily. Your nurse can teach you, or a family member or friend, how to give this yourself. It comes as a ready filled syringe so it is simple to give.

G-CSF as a drip into your bloodstream

You may have G-CSF as a drip into your bloodstream (intravenously). You can have it through a thin, short tube (a cannula) put into a vein in your arm each time you have treatment. Or you may have it through a central line, a portacath or a PICC line. These are long, plastic tubes that give the drugs directly into a large vein in your chest. You have the tube put in just before your course of treatment starts and it stays in place as long as you need it.

If you have G-CSF as an injection under the skin you have it daily for up to 14 days. You have regular blood tests to check your white blood cell count. If you are having it as part of a planned treatment you start at least a day after your chemotherapy and continue until the number of white blood cells called neutrophils is within the normal range.

If you are having pegylated G-CSF you only need to have one injection 24 hours after the end of the chemotherapy.

The side effects associated with G-CSF are listed below. You can use the links to find out more about each side effect. For general information, see our cancer drug side effects section. 

More than 10 in every 100 people have one or more of the side effects listed below.

• Headaches
• Loss of appetite
• Redness and irritation at the injection site
• Fluid retention – your ankles may become swollen
• Feeling or being sick but this is usually well controlled with anti sickness medicines
• Bone pain happens in up to 4 out of 10 people (40%) and is caused by the bone marrow making blood cells – paracetamol can help to control any pain
• Diarrhoea – drink plenty of fluids and tell your doctor or nurse if diarrhoea becomes severe, or continues for more than 3 days
• Constipation – your doctor or nurse may give you laxatives to help prevent this but do tell them if you are constipated for more than 3 days
• This drug may have a harmful effect on a developing baby so talk to your doctor or nurse about contraception before having treatment if there is any chance that you or your partner could become pregnant   

Some people may have one or more of the following side effects

• A skin rash
• High temperature (fever)
• Hair loss
• Dizziness
• Weakness
• Indigestion
• A sore throat
• Tiredness (fatigue)
• Liver changes that are very mild and unlikely to cause symptoms – the liver will almost certainly go back to normal when the treatment ends but you will have regular blood tests to check how well your liver is working
• An enlarged spleen (especially when having G-CSF for stem cell collection) – avoid vigorous exercise, for example, sports such as squash, football or rugby

You need to keep your ready filled syringes in the fridge between 2 and 8°C.

You won’t get all these side effects. A side effect may get worse through your course of treatment. Or you may have more side effects as the course goes on. This depends on

• How many times you've had a drug before
• Your general health
• How much of the drug you have (the dose)
• The way you have the drug
• Other drugs you are having

Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them.

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and over the counter remedies – some drugs can react together.

You should not have immunisations with live vaccines while you are having treatment or for at least 6 months afterwards. In the UK, live vaccines include rubella, mumps, measles (usually given together as MMR), BCG and yellow fever. You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your chemotherapy.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with oral vaccines, but not many people in the UK have oral vaccines now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.