Filgrastim

Filgrastim is the originator recombinant human granulocyte colony-stimulating factor (G-CSF) widely used for preventing neutropaenia-related infections and mobilizing hematopoietic stem cells (1):

• in the hierarchical development of hematopoiesis, G-CSF predominantly stimulates the myeloid cell series from committed progenitor cells to mature neutrophil granulocytes (2)
  • are several important effects of G-CSF:
    • maintaining the viability of progenitor cells and their mature progeny,
    • blocking apoptosis,
    • stimulating cell division,
    • determining lineage affiliation (granulocytes or macrophage monocytes),
    • influencing the maturation process, and stimulating phagocytosis activity
• in chemotherapy-induced neutropaenia, the bone marrow reserve of granulocytes is decreased
• exogenous G-CSF can accelerate proliferation and differentiation of progenitor cells, making neutrophil replenishment more rapidly available and thus shortening the neutropenia phase

A systematic review showed that (1):

• in chemotherapy-induced neutropenia (CIN), filgrastim vs placebo or no treatment significantly reduced febrile neutropenia incidence (RR 0.63, 95% CI 0.53–0.75)
• most commonly reported adverse event (AE) with filgrastim was bone pain

Reference:

1. Dale DC et al. A systematic literature review of the efficacy, effectiveness, and safety of filgrastim. Support Care Cancer. 2018 Jan;26(1):7-20.
2. Link H. Current state and future opportunities in granulocyte colony-stimulating factor (G-CSF). Support Care Cancer. 2022 Sep;30(9):7067-7077