Recombinant human granulocyte-colony stimulating factor for febrile neutropenia during cancer therapy: the first 20 years

Chemotherapy-induced neutropenia is a major risk factor for febrile neutropenia (FN) and also a significant dose-limiting toxicity in cancer treatment. Recombinant human granulocyte-colony stimulating factor (rhG-CSF), such as filgrastim, lenograstim or pegfilgrastim, is available to reduce FN incidence when given prophylactically following chemotherapy. rhG-CSF can effectively reduce the incidence, duration and severity of neutropenia, improve the ability to delivery chemotherapy on schedule, and minimize the risk of FN and infectious morbidity and mortality. Here, we reviewed the physiologic role of G-CSF in granulopoiesis, the indications of rhG-CSF for primary and secondary prophylaxis, existing international guidelines, and associated acute and potential chronic toxicities. There are relevant physiological and clinical evidence for the use of rhG-CSF to ameliorate the myelotoxicity of cancer chemotherapy.