Febrile neutropenia (FN) is a potentially life-threatening side effect of myelosuppressive chemotherapy. Recognizing the effectiveness of colony-stimulating factor (CSF) in reducing the risk and consequences of FN, National Comprehensive Cancer Network (NCCN) guidelines recommend CSF prophylaxis when FN risk is high (> 20%) based on either the chemotherapy regimen alone or a combination of the chemotherapy regimen and patient risk factors [1]. Among the CSFs currently available in the US, pegfilgrastim—which requires one dose per cycle, and is available in a pre-filled syringe or on-body injector—is by far the most commonly used prophylactic CSF agent in clinical practice [2].
Because pegfilgrastim induces proliferation of myeloid progenitor cells, which may be especially sensitive to myelosuppressive drugs, prescribing information specifies that pegfilgrastim should not be administered between 14 days before and 24 h after administration of myelosuppressive chemotherapy.