Granulocyte Colony-Stimulating Factor (Filgrastim) for the Prevention and Management of Chemotherapy-Induced Febrile Neutropenia in Children

Abstract

Background: Febrile neutropenia (FN) is a serious complication of cytotoxic chemotherapy, marked by fever and critically low absolute neutrophil counts, leading to heightened infection risks, morbidity, and treatment interruptions. FN affects up to 40% of patients on standard chemotherapy and is particularly common in regimens for hematologic cancers and solid tumor. Granulocyte colony-stimulating factors (G-CSFs), such as filgrastim, help restore neutrophil counts by stimulating bone marrow activity. Filgrastim reduces the duration and severity of neutropenia, improving treatment continuity. Despite newer agents like pegfilgrastim, filgrastim remains widely used, especially in low-resource settings, though its dosing and side effects require careful management.Aim of the study: This study aims to evaluate the clinical utility of filgrastim in managing chemotherapy-induced FN, focusing on its effectiveness in neutrophil recovery, reduction of hospitalization duration, and overall patient outcomes.Methods: This prospective observational study was conducted at the Pediatric Hematology and Oncology Department of BSMMU in Dhaka, Bangladesh, enrolling 135 children with chemotherapy-induced febrile neutropenia (FN) during 1.5 years, from January 2023 to July 2024. Inclusion required confirmed malignancy, recent chemotherapy, and FN diagnosis, while exclusions included prophylactic G-CSF use and bone marrow failure. Data were collected using a structured form covering demographics, clinical details, chemotherapy regimen, FN onset, and Filgrastim administration (5 μg/kg/day subcutaneously). Outcomes included ANC recovery, fever resolution, hospital stay, ICU need, mortality, and FN recurrence. Data were analyzed using SPSS v26.0 with descriptive statistics.Results:Among 135 patients with chemotherapy-induced febrile neutropenia, the mean age was 16.2

FrontiersinHealthInformaticsISSN-2676-71042024;Vol13:Issue8www.healthinformaticsjournal.comOpenAccess6951years, with 76 males. ALL (Acute Lymphoblastic Leukemia) 48.14%, AML (Acute Myeloid Leukemia)14.81%, NHL(Non-HodgkinLymphoma)14.07%, Ewing’sSarcoma (3.70%), Rhabdomyosarcoma (2.96%), Hodgkin Lymphoma (8.14%), Hepatoblastoma (4.44%), Others (3.70%). FN occurred mainly during the 2nd or 3rd chemotherapy cycle, predominantly with platinum-based regimens. Filgrastim was initiated within 1.2 days of FN onset and continued for 5.6 days. The average ANC recovery time was 4.8 days, and the fever resolved in 2.9 days. Bone pain occurred in 16% of patients. Hospital stay averaged 6.2 days, with a 96% recovery rate, 8% ICU admission, 4% mortality, and 16% FN recurrence in later cycles.Conclusion: Filgrastim effectively reduced the duration of neutropenia, fever, and hospitalization in children with chemotherapy-induced febrile neutropenia. It was well-tolerated with minimal side effects and high recovery rates. These results support its use as a safe and beneficial adjunct in pediatric oncology for managing febrile neutropenia in resource-limited settings.