Granulocyte Colony Stimulating Factor (G-CSF)

G-CSF is a type of growth factor. You may have G-CSF after chemotherapy to help your white blood cells recover after treatment. Or you can have it before and after a stem cell transplant. There are different types of Human Granulocyte Colony Stimulating Factor (rHuGM-CSF), including:

• lenograstim (granulocyte)
• filgrastim (Neupogen, Zarzio, Nivestim, Accofil)
• long-acting filgrastim (pegylated) (pegfilgrastim, Neulasta, Pelmeg, Ziextenco) and pegfilgrastim (Lonquex)

Pegylated G-CSF stays in the body longer, so it is treated less often than other types of G-CSF. This type of G-CSF is not commonly used in the NHS.

How G-CSF works

Growth factors are proteins produced in the body. Some of them cause the bone marrow to produce blood cells. G-CSF is a type of growth factor that causes the bone marrow to make more white blood cells so that it can reduce the risk of infection after some types of cancer treatment. G-CSF also causes some stem cells to pass from the bone marrow into the blood. Stem cells are very early cells that develop into red blood cells, white blood cells, and platelets.

Before a stem cell transplant, you have G-CSF to stimulate your bone marrow to make stem cells and release them into your blood. Stem cells are collected and you then undergo high-dose chemotherapy. The high dose of chemotherapy prevents the bone marrow from making blood cells. So you have the stem cells infused back into your bloodstream. They enter the bone marrow and begin to make the different types of blood cells again.

How do 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 the skin

You usually receive injections under the skin (subcutaneous injection) in the stomach, thigh, or upper arm. You may feel a stinging or dull ache for a short time after this type of injection, but it usually doesn’t hurt much. The skin in the area may become red and itchy for a while.

Into your bloodstream

You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:

• Central line
• PICC line
• portacath

If you don’t have a central line

You might have treatment through a thin short tube (a cannula) that goes into a vein in your arm each time you have treatment.

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

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.

Common side effects

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

• Bone or muscle pain

You might experience pain in your bones or muscles. 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.

• 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 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 petechiae).

• 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 treat it once it has started.

• High temperature (fever)

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

• Breathlessness and looking pale

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

• Hair thinning

Your hair may thin but you’re unlikely to lose all your hair. This usually starts after your first or second cycle of treatment. It is almost always temporary and your hair will grow back when you finish your treatment.

• Sore mouth, throat, gut and back passage

It may be painful to swallow drinks or food. Or you might also have diarrhoea and pain if your bowel is inflamed. This can be caused by inflammation of the mucosa (thin lining of the internal organs). Painkillers can help to reduce soreness. And mouthwashes can help keep your mouth healthy. There might also be numbing gel you could use for your back passage when having a poo.