Accofil (Filgrastim)
Granulocyte Colony-Stimulating Factor (G-CSF) — White Blood Cell Growth Factor
Accofil (filgrastim) is a recombinant human granulocyte colony-stimulating factor (G-CSF) used to stimulate the bone marrow to produce more white blood cells. It is primarily prescribed to reduce the duration and severity of neutropenia (low white blood cell count) following chemotherapy, bone marrow transplantation, or in patients with severe chronic neutropenia. Accofil is administered by subcutaneous injection or intravenous infusion and is available as a biosimilar to the reference medicine Neupogen.
Quick Facts
Key Takeaways
- Accofil (filgrastim) is a biosimilar G-CSF that stimulates the bone marrow to produce more white blood cells, reducing the risk and duration of infection during neutropenia.
- It is used after chemotherapy, bone marrow transplantation, for stem cell mobilization, in severe chronic neutropenia, and in advanced HIV infection.
- The most common side effect is musculoskeletal pain (bone pain), which can typically be managed with standard painkillers such as paracetamol or ibuprofen.
- Accofil must be stored in the refrigerator (2–8 °C) and should not be frozen. It can be kept at room temperature for up to 15 days.
- Patients with sickle cell disease should use Accofil with caution due to the risk of sickle cell crisis. Report any signs of splenic enlargement or rupture immediately.
What Is Accofil and What Is It Used For?
Accofil belongs to a group of medicines called cytokines — specifically, it is a granulocyte colony-stimulating factor (G-CSF). Growth factors like filgrastim are proteins that occur naturally in the human body. However, the filgrastim in Accofil is produced using recombinant DNA technology in Escherichia coli bacteria, making it a biotechnologically manufactured medicine. Accofil works by binding to specific receptors on neutrophil precursor cells in the bone marrow, stimulating their proliferation, differentiation, and maturation into functional white blood cells.
A reduction in the number of white blood cells, a condition known as neutropenia, can occur for various reasons and significantly weakens the body's ability to fight infections. When the absolute neutrophil count (ANC) falls below 0.5 × 109/L, the patient is considered severely neutropenic and at high risk for life-threatening bacterial and fungal infections. Filgrastim accelerates the recovery of neutrophil counts, thereby reducing the incidence, severity, and duration of infections associated with neutropenia.
Accofil is a biosimilar medicine, meaning it has been developed to be highly similar to an already authorized biological medicine called Neupogen (the reference product). The European Medicines Agency (EMA) has approved Accofil after rigorous evaluation demonstrating that it meets the same standards of quality, safety, and efficacy as the reference product. Other biosimilar filgrastim brands include Zarzio and Nivestim.
Approved Indications
Accofil is authorized for use in the following clinical situations:
- Chemotherapy-induced neutropenia: To reduce the duration and incidence of febrile neutropenia in patients receiving cytotoxic chemotherapy for cancer (except chronic myeloid leukemia and myelodysplastic syndromes). This is the most common indication, and filgrastim has been shown to significantly reduce hospitalization rates for neutropenic fever.
- Bone marrow transplant recipients: To accelerate neutrophil recovery following myeloablative therapy and bone marrow or peripheral blood stem cell transplantation, thereby reducing the risk of infection during the engraftment period.
- Peripheral blood stem cell mobilization: In both patients and healthy donors, filgrastim stimulates the release of hematopoietic stem cells from the bone marrow into the peripheral blood, where they can be collected by leukapheresis for subsequent autologous or allogeneic transplantation.
- Severe chronic neutropenia (SCN): Long-term treatment to increase neutrophil counts and reduce the incidence and duration of infection-related events in patients with congenital, cyclic, or idiopathic neutropenia with a history of severe or recurrent infections.
- Advanced HIV infection: To reduce the risk of bacterial infections in patients with persistent neutropenia where other treatment options are inadequate.
The mechanism by which filgrastim exerts its clinical effects involves binding to the G-CSF receptor (CD114) expressed on neutrophil precursor cells. This triggers intracellular signaling pathways, including the JAK-STAT pathway, which promotes cell survival, proliferation, and differentiation. Additionally, filgrastim enhances the functional activity of mature neutrophils, including their ability to perform chemotaxis, phagocytosis, and oxidative burst — all critical components of the innate immune defense against pathogens.
What Should You Know Before Taking Accofil?
Contraindications
Accofil must not be used if you are allergic (hypersensitive) to filgrastim or to any of the other ingredients in this medicine, including glacial acetic acid, sodium hydroxide, sorbitol (E420), polysorbate 80, and water for injections. If you have experienced an allergic reaction to any filgrastim-containing product in the past, you should not use Accofil. It is also important to note that the needle shield on the pre-filled syringe contains dry natural rubber (a derivative of latex), which may cause severe allergic reactions in individuals with latex sensitivity.
Warnings and Precautions
Before starting treatment with Accofil, tell your doctor if you have any of the following conditions:
- Sickle cell disease: Accofil can trigger sickle cell crises, which can be severe and potentially life-threatening. If you have sickle cell trait or sickle cell disease, your doctor will carefully weigh the benefits against the risks before prescribing filgrastim.
- Osteoporosis: Long-term use of filgrastim may be associated with decreased bone density. Your doctor may recommend bone density monitoring during extended treatment courses.
- Pain in the upper left side of the abdomen, under the left ribs, or at the tip of the shoulder — these may indicate splenic enlargement or rupture (splenomegaly), a rare but serious complication.
- Unusual bleeding or bruising, which may indicate decreased platelet counts (thrombocytopenia).
- Sudden signs of allergy such as rash, itching, hives, swelling of the face, lips, tongue, or throat, wheezing, or difficulty breathing — these may indicate a severe allergic reaction (anaphylaxis or angioedema).
- Swelling of the face or ankles, blood in the urine, or brown-colored urine, or noticeably decreased urination — these may indicate kidney injury (glomerulonephritis).
- Fever, abdominal pain, malaise, back pain, and increased inflammatory markers — these may indicate inflammation of the aorta (aortitis), a rare but reported adverse reaction.
If you respond poorly or stop responding to filgrastim treatment, your doctor will investigate the underlying cause, including testing for neutralizing antibodies that may reduce the drug's effectiveness.
Patients with severe chronic neutropenia may be at increased risk of developing blood cancers such as leukemia or myelodysplastic syndrome (MDS). Discuss this risk with your doctor, and understand what monitoring tests are recommended. If you develop or are at high risk for blood cancer, do not use Accofil unless specifically instructed by your physician.
If you are a stem cell donor, you must be between 16 and 60 years of age. There have been infrequent reports of splenic rupture in healthy donors receiving G-CSF for stem cell mobilization, so your doctor will monitor you closely during this process.
Drug Interactions
Tell your doctor or pharmacist about all medicines you are currently taking, have recently taken, or might take. Filgrastim should not be administered within 24 hours before or after cytotoxic chemotherapy, as the rapid proliferation of myeloid cells during filgrastim treatment could make them more sensitive to the effects of chemotherapy drugs, potentially worsening myelosuppression.
| Interacting Drug | Effect | Recommendation |
|---|---|---|
| Cytotoxic chemotherapy agents | Rapidly dividing myeloid cells may be more sensitive to cytotoxic agents, potentially increasing myelosuppression | Do not give filgrastim within 24 hours before or after chemotherapy |
| Lithium | Lithium promotes release of neutrophils and may potentiate the effect of filgrastim | Monitor white blood cell counts more frequently if used concurrently |
| Topotecan | Concurrent use may prolong the duration of neutropenia | Allow adequate interval between topotecan and filgrastim doses |
| 5-Fluorouracil (5-FU) | May aggravate neutropenia when given concomitantly | Follow oncologist's timing guidance carefully |
Pregnancy and Breastfeeding
Accofil has not been adequately studied in pregnant or breastfeeding women and is therefore not recommended during pregnancy. Animal studies have shown some reproductive toxicity, and the potential risk to the human fetus is unknown. It is important to tell your doctor before using Accofil if you are pregnant, think you may be pregnant, or are planning to have a baby. If you become pregnant during treatment, contact your doctor immediately.
It is not known whether filgrastim passes into human breast milk. Because many drugs are excreted in breast milk and because of the potential for adverse effects in the nursing infant, you must discontinue breastfeeding during Accofil treatment unless your doctor advises otherwise.
Driving and Operating Machinery
Accofil may have a minor effect on your ability to drive and use machines. This medicine can cause dizziness in some patients. If you experience dizziness or other symptoms that impair your alertness, you should wait until the effects resolve before driving or operating machinery.
Important Information About Excipients
- Sorbitol: This medicine contains 50 mg sorbitol per ml. Sorbitol is a source of fructose. Patients with hereditary fructose intolerance (HFI) must not use this medicine, as it can cause serious adverse effects.
- Sodium: This medicine contains less than 1 mmol (23 mg) sodium per pre-filled syringe and is essentially sodium-free.
- Latex: The needle shield contains dry natural rubber (a latex derivative), which may cause severe allergic reactions in latex-sensitive individuals.
What Is the Correct Dosage of Accofil?
Always use Accofil exactly as your doctor has told you. The dose and duration of treatment depend on your medical condition, body weight, and how well you respond to treatment. Your doctor will monitor your white blood cell counts regularly with blood tests to determine when treatment can be stopped or if dose adjustments are needed.
| Indication | Dose | Route | Duration |
|---|---|---|---|
| Chemotherapy-induced neutropenia | 5 mcg/kg/day (0.5 MU/kg/day) | SC injection | Until neutrophil count recovers to normal range (usually 14 days, up to 38 days) |
| Bone marrow transplant | 10 mcg/kg/day (1.0 MU/kg/day) | IV infusion (over 30 min or 24 h) | Starting ≥24 h after chemotherapy and ≥24 h after transplant; until neutrophils recover |
| Stem cell mobilization (patients) | 10 mcg/kg/day (1.0 MU/kg/day) | SC injection | For 5–7 days; leukapheresis on days 5, 6, 7 |
| Stem cell mobilization (healthy donors) | 10 mcg/kg/day (1.0 MU/kg/day) | SC injection | For 4–5 days; leukapheresis on day 5 (and 6 if needed) |
| Severe chronic neutropenia (congenital) | 12 mcg/kg/day (1.2 MU/kg/day) | SC injection | Long-term; dose adjusted to maintain ANC 1.5–10 × 109/L |
| Severe chronic neutropenia (idiopathic/cyclic) | 5 mcg/kg/day (0.5 MU/kg/day) | SC injection | Long-term; dose adjusted to maintain ANC 1.5–10 × 109/L |
| HIV-associated neutropenia | 1–4 mcg/kg/day (0.1–0.4 MU/kg/day) | SC injection | Until neutrophil count is maintained >2.0 × 109/L |
Adults
For most adult patients, Accofil is administered as a once-daily subcutaneous injection. The typical starting dose for chemotherapy-induced neutropenia is 5 micrograms per kilogram of body weight per day (equivalent to 0.5 million units/kg/day). Treatment usually begins no earlier than 24 hours after the last dose of cytotoxic chemotherapy. Your doctor will perform regular blood tests to monitor your absolute neutrophil count and will adjust the dose or discontinue treatment accordingly. For bone marrow transplant recipients, a higher starting dose of 10 mcg/kg/day is typically used, administered as a 30-minute or 24-hour intravenous infusion.
Children
Accofil is used to treat children who are receiving chemotherapy or who have very low white blood cell counts (neutropenia). The dosing for children receiving chemotherapy is the same as for adults, calculated on a per-kilogram body weight basis. For children with severe chronic neutropenia, doses are individualized based on the type of neutropenia (congenital versus idiopathic/cyclic) and the clinical response. Safety and efficacy data in children are consistent with those observed in adult populations.
Elderly
No specific dose adjustments are required for elderly patients. However, as older patients may have reduced renal and hepatic function, and may be more susceptible to certain adverse effects such as splenic enlargement, careful clinical monitoring is recommended. The dosing principles are the same as for younger adults.
Missed Dose
If you forget an injection or inject too little, contact your doctor as soon as possible. Do not take a double dose to make up for a missed dose. Your doctor will advise you on the best course of action, which may involve resuming your normal dosing schedule or adjusting the timing of your next injection.
Overdose
Do not increase the dose your doctor has prescribed. If you believe you have injected more Accofil than recommended, contact your doctor as soon as possible. Effects of overdose are not well characterized, but excessive doses would be expected to intensify the known pharmacological effects, including a marked increase in white blood cell counts and potentially an increased risk of adverse effects such as bone pain, splenic enlargement, and thrombocytopenia.
Self-Injection Instructions
Patients or their caregivers may be trained to administer subcutaneous injections at home. Do not attempt self-injection without first receiving proper training from a healthcare professional. When self-injecting:
- Remove the syringe from the refrigerator and allow it to reach room temperature for approximately 30 minutes. Do not use a microwave or hot water to warm it.
- Wash your hands thoroughly and prepare a clean, well-lit workspace.
- Inspect the solution — it must be clear and colorless with no visible particles. Check the expiration date. Do not use if expired, cloudy, or discolored.
- Choose an injection site (upper thigh or abdomen, avoiding the navel area). Rotate sites daily to prevent soreness.
- Clean the injection site with an alcohol swab.
- Remove the needle cap and adjust the dose if your doctor has prescribed less than the full syringe contents.
- Pinch the skin and insert the needle at a 45–90 degree angle. Pull back the plunger slightly — if blood appears, withdraw and try a different site.
- Inject slowly with steady pressure until the syringe is empty.
- Remove the needle and dispose of the syringe in a sharps container. Each syringe is for single use only.
What Are the Side Effects of Accofil?
Like all medicines, Accofil can cause side effects, although not everybody experiences them. The frequency and severity of side effects may vary depending on the underlying condition being treated, the dose used, and individual patient factors. Many of the side effects listed below (such as anemia, thrombocytopenia, nausea, and fatigue) may also be related to the underlying disease or concurrent chemotherapy treatment rather than to filgrastim itself.
- An allergic reaction with weakness, blood pressure drop, breathing difficulties, facial swelling (anaphylaxis), skin rash, itchy rash (urticaria), or difficulty breathing (dyspnea)
- Cough, fever, and breathing difficulties, which may indicate acute respiratory distress syndrome (ARDS)
- Kidney damage (glomerulonephritis) — swelling of the face or ankles, blood or dark color in the urine, reduced urination
- Pain in the left upper abdomen or left shoulder — possible splenic enlargement or rupture
- Swelling, difficulty breathing, abdominal bloating, and general tiredness developing rapidly — possible capillary leak syndrome
- Fever, confusion, rapid heart rate, extreme pain, clammy skin — possible sepsis
Side Effects by Frequency
Very Common
Affects more than 1 in 10 people
- Musculoskeletal pain (bone pain, back pain, joint pain, muscle pain)
- Nausea
- Vomiting
- Hair loss or thinning (alopecia)
- Fatigue and exhaustion
- Inflammation and soreness of the mucous membranes (mucositis)
- Decreased platelet count (thrombocytopenia)
- Low red blood cell count (anemia)
- Fever (pyrexia)
- Headache
- Diarrhea
Common
Affects up to 1 in 10 people
- Lung inflammation (bronchitis), upper respiratory infections
- Urinary tract infection
- Decreased appetite, insomnia
- Dizziness, numbness or tingling (paresthesia)
- Low blood pressure (hypotension) or high blood pressure (hypertension)
- Cough, coughing up blood (hemoptysis), nosebleeds
- Mouth and throat pain, constipation
- Liver enlargement (hepatomegaly)
- Skin rash, redness (erythema), muscle spasms
- Painful urination, chest pain, general weakness (asthenia)
- Swelling of hands and feet (peripheral edema)
- Elevated blood enzymes, transfusion reactions
Uncommon
Affects up to 1 in 100 people
- Increased white blood cells (leukocytosis)
- Allergic reactions (hypersensitivity)
- Graft-versus-host disease (GvHD)
- Elevated uric acid levels (hyperuricemia, may cause gout)
- Liver damage from blocked small veins (veno-occlusive disease)
- Respiratory failure, pulmonary edema, lung inflammation (interstitial lung disease)
- Pulmonary hemorrhage, reduced oxygen uptake (hypoxia)
- Raised skin rash (maculopapular rash)
- Osteoporosis (reduced bone density)
- Injection site reactions
Rare
Affects up to 1 in 1,000 people
- Inflammation of the aorta (aortitis)
- Severe bone, chest, intestinal, or joint pain (sickle cell crisis)
- Life-threatening allergic reaction (anaphylactic reaction)
- Pseudogout (pain and swelling in joints resembling gout)
- Fluid volume disturbances
- Cutaneous vasculitis (inflammation of blood vessels in the skin)
- Sweet's syndrome (painful, raised, plum-colored skin lesions with fever)
- Worsening of rheumatoid arthritis
- Abnormal changes in urine, decreased bone density
- Extramedullary hematopoiesis (blood cell formation outside the bone marrow)
A very common side effect specific to filgrastim use is musculoskeletal pain, particularly bone pain. This occurs because the drug stimulates increased activity in the bone marrow. The pain is usually mild to moderate and can be managed with standard painkillers such as paracetamol (acetaminophen) or ibuprofen. If pain becomes severe, your doctor may need to adjust your dose or provide stronger pain relief.
In patients undergoing stem cell or bone marrow transplantation, graft-versus-host disease (GvHD) may occur. This is a reaction of the donor cells against the recipient's tissues, which can manifest as skin rash on the palms or soles, mouth ulcers, liver inflammation, and involvement of the eyes, lungs, or joints.
In healthy stem cell donors, an increase in white blood cell count (leukocytosis) and a decrease in platelet count (thrombocytopenia) are frequently observed. Your doctor will monitor blood counts regularly during and after the donation process.
If you experience any side effects, including those not listed here, talk to your doctor, pharmacist, or nurse. You can also report suspected side effects directly to your national medicines regulatory authority. By reporting side effects, you help provide valuable safety information about this medicine.
How Should You Store Accofil?
Proper storage of Accofil is essential to maintain the medicine's effectiveness and safety. As a biological product containing a recombinant protein, filgrastim is sensitive to temperature extremes, light exposure, and physical agitation. Follow these storage guidelines carefully:
- Refrigerate: Store in a refrigerator at 2 °C to 8 °C (36 °F to 46 °F). Keep the pre-filled syringe in the outer carton to protect from light.
- Do not freeze: Freezing can damage the protein structure and render the medicine ineffective. However, accidental exposure to freezing temperatures for up to 48 hours does not affect stability. If frozen for more than 48 hours or frozen more than once, discard the product.
- Room temperature use: The syringe may be removed from the refrigerator and stored at room temperature (not above 25 °C / 77 °F) for a single period of up to 15 days. After this period, the product must be discarded and must not be returned to the refrigerator.
- Before injection: For a more comfortable injection, allow the pre-filled syringe to reach room temperature for approximately 30 minutes, or hold it gently in your hand for a few minutes. Do not warm by any other method.
- Visual inspection: Before use, check that the solution is clear and colorless. Do not use if the solution appears cloudy, discolored, or contains visible particles.
- Expiration: Check the expiration date on the label. The expiry date refers to the last day of the indicated month. Do not use after the expiration date.
- Keep out of reach: Store out of the sight and reach of children.
Do not replace the needle cap on used needles, as this increases the risk of accidental needle-stick injury. Dispose of used syringes in an approved sharps disposal container according to your local regulations. Do not dispose of medicines in household waste or via the sewage system.
Dilution and Preparation (Healthcare Professionals)
When dilution is required, Accofil may be diluted in 5% glucose (dextrose) solution only. It must not be diluted with sodium chloride (normal saline) solution, as this may cause adsorption of the drug to glass and plastic materials. Dilution to a final concentration below 0.2 MU (2 micrograms) per ml is not recommended. For concentrations below 1.5 MU (15 micrograms) per ml, human serum albumin (HSA) should be added to a final concentration of 2 mg/ml to prevent adsorption. After dilution in 5% glucose, Accofil is compatible with glass and various plastics including PVC, polyolefin, and polypropylene. The diluted solution is physically and chemically stable for up to 30 hours at 25 °C, but from a microbiological standpoint, it should be used immediately.
What Does Accofil Contain?
Understanding the complete composition of Accofil is important, particularly if you have known allergies or intolerances to specific excipients. Below is the full breakdown of the medicine's contents:
Active Substance
The active substance is filgrastim, a recombinant human granulocyte colony-stimulating factor (rhG-CSF) produced in Escherichia coli using recombinant DNA technology. Each pre-filled syringe contains either:
- 12 MU (120 micrograms) filgrastim in 0.2 ml solution, corresponding to a concentration of 0.6 mg/ml, or
- 30 MU (300 micrograms) filgrastim in 0.5 ml solution, corresponding to a concentration of 0.6 mg/ml
Other Ingredients (Excipients)
- Glacial acetic acid (pH adjustment)
- Sodium hydroxide (pH adjustment)
- Sorbitol (E420) — 50 mg per ml (source of fructose; contraindicated in hereditary fructose intolerance)
- Polysorbate 80 (stabilizer)
- Water for injections
Appearance and Packaging
Accofil is a clear, colorless solution for injection/infusion supplied in pre-filled syringes. Each syringe is graduated with printed markings from 0.1 ml to 1 ml in 1/40 increments. The syringes are available with or without an attached needle guard. Accofil is supplied in pack sizes of 1, 3, 5, 7, or 10 pre-filled syringes, with or without alcohol swabs. Not all pack sizes may be available in all markets.
The marketing authorization holder is Accord Healthcare S.L.U., Barcelona, Spain. Manufacturing is carried out by Accord Healthcare Polska Sp.z o.o. (Pabianice, Poland) and Accord Healthcare Single Member S.A. (Schimatari, Greece).
Frequently Asked Questions About Accofil
Accofil (filgrastim) is used to stimulate the bone marrow to produce more white blood cells (neutrophils). It is prescribed to reduce the duration and severity of neutropenia after chemotherapy, after bone marrow transplantation, to mobilize stem cells for collection, in severe chronic neutropenia (congenital, cyclic, or idiopathic), and in patients with advanced HIV infection to reduce infection risk. By boosting white blood cell production, Accofil helps the body fight infections during periods when the immune system is compromised.
Accofil is given as a daily subcutaneous injection (under the skin) or as a slow intravenous infusion, depending on the clinical indication. For most patients, subcutaneous injection is preferred and can be self-administered at home after receiving proper training from a healthcare professional. The pre-filled syringes are designed for ease of use, and injections are typically given in the upper thigh or abdomen. Rotate injection sites daily to minimize local soreness.
The most characteristic side effect of filgrastim is musculoskeletal pain (especially bone pain), which occurs because the drug stimulates increased bone marrow activity. Other very common side effects include nausea, vomiting, hair loss, fatigue, mucositis, thrombocytopenia, anemia, fever, headache, and diarrhea. Many of these effects are also associated with the underlying condition or concurrent chemotherapy. Bone pain can usually be managed with standard painkillers such as paracetamol or ibuprofen.
Accofil must be stored in a refrigerator at 2–8 °C and must not be frozen. It can be taken out of the refrigerator and kept at room temperature (not above 25 °C) for a single period of up to 15 days. After this period, it should be discarded. Always keep the pre-filled syringe in its original carton to protect from light, and inspect the solution before use — it should be clear and colorless with no particles.
Accofil is a biosimilar medicine containing the same active substance (filgrastim) as the reference medicine Neupogen. A biosimilar is a biological medicine that is highly similar to another biological medicine already approved in the EU. The European Medicines Agency (EMA) has approved Accofil after comprehensive evaluation showing it meets the same strict standards of pharmaceutical quality, safety, and efficacy as the reference product. Other approved filgrastim biosimilars include Zarzio and Nivestim. Your doctor may prescribe any of these interchangeably based on availability and local guidelines.
Accofil is not recommended during pregnancy, as it has not been adequately studied in pregnant women and animal studies have shown some reproductive effects. If you are pregnant, think you may be pregnant, or are planning a pregnancy, inform your doctor before starting treatment. Breastfeeding should be discontinued during Accofil treatment, as it is not known whether filgrastim passes into breast milk. If you become pregnant during treatment, contact your doctor immediately to discuss the potential risks and benefits of continuing therapy.
References
This article is based on evidence from internationally recognized medical sources. All information has been reviewed for accuracy against current clinical guidelines and peer-reviewed research.
- European Medicines Agency (EMA). Accofil: EPAR – Product Information. Last updated 2025. Available at: EMA – Accofil.
- Smith TJ, Bohlke K, Lyman GH, et al. Recommendations for the use of WBC growth factors: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2015;33(28):3199-3212. doi:10.1200/JCO.2015.62.3488
- National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology: Hematopoietic Growth Factors. Version 1.2025.
- World Health Organization (WHO). WHO Model List of Essential Medicines – 23rd List (2023). Filgrastim is included as an essential medicine for chemotherapy-induced neutropenia.
- Aapro MS, Bohlius J, Cameron DA, et al. 2010 update of EORTC guidelines for the use of granulocyte-colony stimulating factor to reduce the incidence of chemotherapy-induced febrile neutropenia in adult patients with lymphoproliferative disorders and solid tumours. Eur J Cancer. 2011;47(1):8-32.
- Crawford J, Dale DC, Lyman GH. Chemotherapy-induced neutropenia: risks, consequences, and new directions for its management. Cancer. 2004;100(2):228-237.
- Dale DC, Cottle TE, Fier CJ, et al. Severe chronic neutropenia: treatment and follow-up of patients in the Severe Chronic Neutropenia International Registry. Am J Hematol. 2003;72(2):82-93.
- British National Formulary (BNF). Filgrastim. National Institute for Health and Care Excellence (NICE). Available at: bnf.nice.org.uk.
- Lyman GH, Dale DC, Culakova E, et al. The impact of the granulocyte colony-stimulating factor on chemotherapy dose intensity and cancer survival: a systematic review and meta-analysis of randomized controlled trials. Ann Oncol. 2013;24(10):2475-2484.
- European Medicines Agency (EMA). Guideline on similar biological medicinal products containing biotechnology-derived proteins as active substance: non-clinical and clinical issues. EMEA/CHMP/BMWP/42832/2005 Rev1. 2014.
Medical Editorial Team
This article was written and reviewed by the iMedic Medical Editorial Team, which includes board-certified physicians specializing in oncology, hematology, and clinical pharmacology. Our team follows international editorial standards and the GRADE evidence framework to ensure all medical information is accurate, current, and evidence-based.
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