Filgrastim for Stem Cell Donors

What is filgrastim?

Filgrastim is a medicine that is similar to a substance that is normally made in the body. This substance helps the bone marrow make new white blood cells. Filgrastim is given before stem cell collection to increase the number of the blood-forming cells that will be in the bloodstream when a donor gives their blood for a transplant. Filgrastim may also be given before bone marrow donation in some cases.

You may hear filgrastim called granulocyte colony stimulating factor (G-CSF) or by its brand name, Neupogen. Filgrastim comes as a clear liquid for injection. It is usually given just under the skin (subcutaneously or "sub-Q").

Before receiving filgrastim from the doctor and taking it or giving it to your child:

Tell your doctor if you or your child have ever reacted badly to filgrastim or to any other drug product.

Talk with your doctor or pharmacist if you or your child have any of the following conditions. Precautions may need to be taken with this medicine if you or your child have:

• heart problems
• sickle cell disease
• inflammatory or immune system problems
• lung disease

How should filgrastim be given?

In some cases, you or your child will come to the hospital to receive injections of filgrastim. In other cases, a nurse may come to your home to give the medicine or you may give the injections yourself. If you are doing the injections yourself at home:

• Make sure you understand and are comfortable with the way to prepare and inject filgrastim and know how to dispose of the needle and syringe. These procedures will be explained to you by your nurse, doctor, or pharmacist.
• Do not shake the vial of filgrastim.
• A vial of filgrastim is good for 24 hours once the stopper has been poked.

What should you do if you or your child misses a dose of filgrastim?

Notify your health care team right away that a dose was missed and discuss a plan.

What are the possible side effects of filgrastim?

You or your child may have some of these side effects while taking filgrastim. Check with the doctor if you or your child continue to have any of these side effects, and they do not go away, or they bother you or your child:

• mild headache
• fever or flu-like symptoms
• tiredness
• stomach upset (nausea)
• bone pain, especially in the lower back or hips
• muscle aches or pains
• slight redness or irritation at site of injection

Most of the following side effects are not common, but they may be a sign of a serious problem.
Call the doctor right away or go to Emergency if you or your child have any of these side effects:

• raised, itchy, red blotches on skin (hives)
• rash
• swelling of the lips
• tightness of the throat or difficulty breathing
• severe headache
• unusual bleeding or bruising
• blood in the urine or stool
• black, tarry stools
• pain in the upper left side of the belly or shoulder
• chest or jaw pain
• a lot of perspiration (sweating)

What safety measures should you take when you or your child use filgrastim?

Talk to the doctor if you or your child are receiving any chemotherapy, radiation, or are taking the medication lithium.

Keep all appointments with the doctor who will be monitoring the treatment with filgrastim.

Check with the doctor or pharmacist before using any other medicines (prescription, non-prescription, or herbal products).

What other important information should you know about filgrastim?

• It is possible that the use of filgrastim in healthy people may increase the chance of developing certain types of cancers. However, studies that have looked at the rate of cancers in people who have received filgrastim to donate stem cells or bone marrow suggest that this is NOT the case. The transplant doctor can give you more information if you have concerns.
• If you or your child are getting filgrastim at home, make sure you have arranged to have a supply before leaving the hospital. Not all pharmacies carry this medication.
• If you or your child have mild pain following filgrastim, acetaminophen (e.g. Tylenol) may be used. Check the package information or check with your pharmacist or nurse for information on the dose to use. Please contact your health care team in the morning as stronger medication may be needed.
• For irritation at the site of injection, cold compresses may be used.
• Keep a list of all medications you or your child are on to show the doctor or pharmacist.
• Do not share your child's medicine with others. Do not give anyone else's medicine to your child.
• Store filgrastim in the refrigerator. Do not freeze this medicine. Be sure to store this medication properly as it is very expensive.
• Do not keep any medicines that are out of date. Check with your pharmacist about the best way to throw away outdated or leftover medicines.
• The dose that should be given is: ____________ mcg which is equal to ____________ mL.
• If you need to contact someone outside of clinic hours, for example overnight or on weekends, please phone: __________________________________

Keep filgrastim out of your child’s sight and reach and locked up in a safe place. If your child takes too much filgrastim, call your local Poison Information Centre at one of these numbers. These calls are free. 

• Call 1-844 POISON-X, or 1-844-764-7669, from anywhere in Canada except Quebec.
• Call 1-800-463-5060 if you live in Quebec.