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Granulocyte colony stimulating factor (G-CSF)

G-CSF is a type of growth factor. You might have G-CSF after chemotherapy to help your white blood cells recover after treatment. Or you might have it before and after a stem cell transplant.

There are different types of G-CSF, including:

  • lenograstim (Granocyte)
  • filgrastim (Neupogen, Zarzio, Nivestim, Ratiograstim)
  • long acting (pegylated) filgrastim (pegfilgrastim, Neulasta) and lipegfilgrastim (Lonquex)

Pegylated G-CSF stays in the body for longer so you have treatment less often than with the other types of G-CSF. This type of G-CSF is not commonly used in the NHS. 

How it works

Growth factors are proteins made in the body. Some of them make the bone marrow produce blood cells. G-CSF is a type of growth factor that makes the bone marrow produce white blood cells to reduce the risk of infection after some types of cancer treatment. 

G-CSF also makes some stem cells move from the bone marrow into the blood. Stem cells are the cells in the bone marrow that make red blood cells, white cells and platelets.

Before a stem cell transplant, 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 high dose of chemotherapy stops your bone marrow producing blood cells. So you have the stem cells back into your bloodstream. They go into the bone marrow and start making the different types of blood cells again. 

How you have it

Most people have G-CSF as an injection under the skin. You can also have it as a drip into your bloodstream (intravenously).  

Injection under your skin

You usually have injections under the skin (subcutaneous injection) into the stomach, thigh or top of your arm.

You might have stinging or a dull ache for a short time after this type of injection but they don't usually hurt much. The skin in the area may go red and itchy for a while.

The video below shows you how to give an injection just under your skin (subcutaneously). 

Into your bloodstream

You have the treatment through a drip into your arm or hand. A nurse puts a small tube (a cannula) into one of your veins and connects the drip to it.

You might need a central line. This is a long plastic tube that gives the drugs into a large vein, either in your chest or through a vein in your arm. It stays in while you’re having treatment, which may be for a few months.

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

Side effects

We haven't listed all the side effects. It is very unlikely that you will have all of these side effects, but you might have some of them at the same time.

How often and how severe the side effects are can vary from person to person. They also depend on what other treatment you are having. For example, your side effects could be worse if you are also having other drugs or radiotherapy.

When to contact your team

Your doctor or nurse will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

  • you have severe side effects 
  • your side effects aren’t getting any better
  • your side effects are getting worse
Early treatment can help manage side effects better.

Common side effects

These side effects happen in more than 10 in 100 people (10 %). You might have one or more of them. They include:

Liver changes 

You might have liver changes that are usually mild and unlikely to cause symptoms. They usually go back to normal when treatment finishes. You have regular blood tests to check for any changes in the way your liver is working.

Bone pain 

You might experience pain in your bones. Speak to your doctor as they can prescribe medicine to help. 

Headaches

Tell your doctor or nurse if you keep getting headaches. They can give you painkillers to help.

Tiredness and weakness (fatigue)

Tiredness and weakness (fatigue) can happen during and after treatment - doing gentle exercises each day can keep your energy up. Don't push yourself, rest when you start to feel tired and ask others for help.

Back pain

You might feel some pain from your muscles and joints. Speak to your doctor or nurse about what painkillers you can take to help with this.

High white blood cell count 

You will have regular blood tests to check for this. 

Bruising, bleeding gums or nosebleeds

This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechia).

Diarrhoea

Contact your advice line if you have diarrhoea, such as if you've had 4 or more loose watery poos (stools) in 24 hours. Or if you can't drink to replace the lost fluid. Or if it carries on for more than 3 days. Your doctor may give you anti diarrhoea medicine to take home with you after treatment. Eat less fibre, avoid raw fruits, fruit juice, cereals and vegetables, and drink plenty to replace the fluid lost.

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques, can all help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treating it once it has started.

High temperature (fever)

If you get a high temperature, let your treatment team know straight away. Ask them if you can take paracetamol to help lower your temperature.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (1 to 10%). You might have one or more of them. They include:

  • enlarged spleen
  • inflammation around the injection site
  • tummy (abdominal) pain
  • swollen hands and feet (oedema)
  • skin rash
  • constipation
  • difficulty sleeping (insomnia)
  • breathlessness and cough
  • pain passing urine

Rare side effects

Each of these effects happens in fewer than 1 out of 100 people (1%). You might have one or more of them They include:

  • allergic reaction
  • capillary leak syndrome

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do I need to know?

Other medicines, foods and drink 

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

Pregnancy and contraception

This treatment might harm a baby developing in the womb. It is important not to become pregnant or father a child while you're having treatment and for a few months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.

Breastfeeding 

Don’t breastfeed during this treatment because the drug may come through into your breast milk.

Treatment for other conditions 

Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.

Storing G-CSF

You need to keep your ready-filled syringes in the fridge between 2 and 8°C, except for lenograstim, which is stored at room temperature.

More information about this treatment

For further information about this treatment go to the electronic Medicines Compendium (eMC) website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.

Last reviewed: 
18 Jul 2019
  • Electronic Medicines Compendium 

    Accessed July 2019

  • Neutropenic sepsis: prevention and management in people with cancer
    The National Institute for Health and Care Excellence (NICE), 2012

  • Guideline for the use of granulocyte colony stimulating factor (G-CSF) for adults in oncology and haematology
    Norfolk and Norwich University Hospitals NHS Foundation Trust, 2017

  • 2006 Update of ASCO Practice Guideline Recommendations for the Use of White Blood Cell Growth Factors: Guideline Summary
    Journal of Oncology Practice, 2006. Vol 2, number 4, pages 196-201

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