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ASCOWBC1713
Table 3. Dosing and Administration of CSFs
Agent Dosing and Administration
Filgrastim
/
Filgrastim-sndz
• Filgrastim should be started 1–3 days after administration of myelotoxic
chemotherapy.
• In the setting of high-dose therapy and autologous stem-cell rescue, filgrastim can be
started 1–5 days after administration of high-dose therapy.
• Filgrastim should be continued until reaching ANC ≥2–3 × 10
9
/L.
• For PBPC mobilization, filgrastim should be started ≥4 days before first
leukapheresis procedure and continued until last leukapheresis.
• In adults, the recommended filgrastim dose is 5 µg/kg per day for all clinical settings
other than PBPC mobilization.
• In the setting of PBPC mobilization, dose of 10 µg/kg per day may be preferable.
• The preferred route of filgrastim administration is subcutaneous.
Tbo-
filgrastim
• Tbo-filgrastim should be started 1–3 days after administration of myelotoxic
chemotherapy.
• In adults the recommended tbo-filgrastim dose is 5 µg/kg per day.
• The preferred route of tbo-filgrastim administration is subcutaneous.
Pegfilgrastim
• Pegfilgrastim 6 mg should be administered once 1–3 days after chemotherapy,
if possible.
• Because some patients will not be able to return for a dose of pegfilgrastim because
of distance or immobility, for instance, alternatives to consider may include self-
administered filgrastim or tbo-filgrastim or same-day pegfilgrastim, recognizing that
although same-day pegfilgrastim is not as effective as later pegfilgrastim, it is better
than no pegfilgrastim.
• Pegfilgrastrim is also available in a timed automated-inject device that delivers 6 mg
of pegfilgrastrim subcutaneously, 27 hours after it is placed on skin and activated.
• Pegfilgrastim is not currently indicated for stem-cell mobilization.
• 6 mg formulation should not be used in infants, children, or small adolescents who
weigh <45 kg.
Sargramostim
• Because GM-CSFs have been licensed specifically for use in mobilization and after
transplantation of autologous PBPCs, after autologous or allogeneic bone marrow
transplantation, and for AML, manufacturer's instructions for administration are
limited to those clinical settings.
• GM-CSFs should be initiated on day of bone marrow infusion and not <24 hours
after last chemotherapy and 12 hours after most recent radiotherapy.
• GM-CSFs should be continued until ANC >1.5 × 10
9
/L for 3 consecutive days is
achieved.
• Drug should be discontinued early or dose reduced by 50% if ANC increases to
>20 × 10
9
/L.
• Recommended dose for adults is 250 µg/m
2
per day.
ASCO believes that cancer clinical trials are vital to inform medical decisions and
improve cancer care and that all patients should have the opportunity to participate.
Additional information, which may include data supplements, slide sets, patient
versions, frequently asked questions, and other clinical tools and resources, is available at
www.asco.org/guidelines/wbcgf and www.asco.org/guidelineswiki
