Side effects of using granulocyte-colony stimulating factors as prophylaxis of febrile neutropenia in cancer patients: A systematic review

Introduction: We systematically reviewed the literature regarding short- and long-term safety and tolerability of prophylactic use of Granulocyte-Colony Stimulating Factor (G-CSF) for chemotherapy-related febrile neutropenia (FN). Methods: 730 pertinent records published from 1994 to 2020 were identified. Exclusion criteria included no assessment of safety or Quality of life (QOL). Results: Among 88 full-texts included, most studies were conducted during or shortly after G-CSF administration. Mild-to-moderate medullary bone pain was the most reported side effect, usually responsive to anti-inflammatory drugs although potentially impactful on daily functioning. Transient leukocytosis, thrombocytopenia and alterations in biochemistry were also commonly reported. Short-term improvements in patient-reported outcomes were observed as a result of reduction of FN and secondary complications. Secondary myeloid neoplasms were the only reported late effect. No studies evaluated the long-term impact on QOL. Conclusions: G-CSF seem safe and well-tolerated, although few data are available on long-term impact of use of G-CSF.