Treatment of chemotherapy-induced neutropenia by subcutaneously administered granulocyte colony-stimulating factor with optimization of dose and duration of therapy

J Clin Oncol. 1989 Oct;7(10):1554-62. doi: 10.1200/JCO.1989.7.10.1554.


In patients who have not received extensive prior chemotherapy or radiotherapy, it has been previously demonstrated that granulocyte colony-stimulating factor (G-CSF) abrogated the leukopenia following administration of melphalan (25 mg/m2). This study examined the necessity of a prechemotherapy period of G-CSF administration and the effect of varying the timing and duration of postchemotherapy G-CSF. Initially, patients received 0.3, 1.0, 3.0, and 10 micrograms/kg/d subcutaneously on days 1 to 5 and days 10 to 18. Melphalan was given on day 9. In the next portion of the study melphalan was administered on day 1 and G-CSF, 10 micrograms/kg/d, was administered by subcutaneous infusion on five schedules: (1) days 2 to 13; (2) days 8 to 13; (3) days 2 to 18; (4) days 8 to 18; (5) days -9 to -2 and 2 to 13. G-CSF produced a rapid and sustained elevation in neutrophil levels within 24 hours even when started 8 days after melphalan. This treatment was sufficient to abrogate the neutropenia in patients who had received no prior chemotherapy. It was not necessary to continue G-CSF for more than 7 days. G-CSF did not consistently alter the course of the thrombocytopenia that followed this dose of melphalan. G-CSF was well tolerated, although mild bone pain occurred and was reduced with acetaminophen. One of 22 patients developed cellulitis at an infusion site. We conclude that after melphalan chemotherapy, G-CSF may need to be given for only a short period to prevent chemotherapy-induced neutropenia, and that G-CSF induces a rapid rise in neutrophil levels even when started 8 days after melphalan administration.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Agranulocytosis / drug therapy*
  • Colony-Stimulating Factors / adverse effects
  • Colony-Stimulating Factors / pharmacokinetics
  • Colony-Stimulating Factors / therapeutic use*
  • Drug Evaluation
  • Female
  • Humans
  • Leukocyte Count / drug effects
  • Male
  • Melphalan / adverse effects
  • Middle Aged
  • Neoplasms / drug therapy
  • Neutropenia / chemically induced
  • Neutropenia / drug therapy*
  • Neutrophils


  • Colony-Stimulating Factors
  • Melphalan