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Granulocyte colony-stimulating factor (pegylated)

Pegfilgrastim

NeulastaG-CSF

How it works

Stimulates neutrophil production. Given prophylactically after high-risk chemo (GnP, mFFX) to reduce febrile neutropenia.

Fixed dose 6 mg SC ≥ 24 h after chemo. Both mFFX and GnP carry > 20% FN risk and qualify for ASCO/NCCN primary prophylaxis. Bone pain typically D3–D5 — normalise and treat symptomatically with paracetamol.

Dosing

Typical doses

  • 6 mg SC once per cycle (24–72h after chemo)

Schedule

  • D2 of cycle (day after last chemo dose)
    cycle_linked

Side Effects

  • Bone pain (myalgia, lower back), usually D3–D5
  • Injection site reaction (soreness, erythema)
  • Splenic rupture (extremely rare)
  • ARDS (acute respiratory distress syndrome, very rare)

Monitoring

  • Counsel on bone pain — usually resolves with acetaminophen
  • FBC at D10–14 to confirm neutrophil recovery