Recommended Dose of G-CSF for a 125kg Male
For a 125kg male, the recommended dose of G-CSF (filgrastim) is 5 μg/kg/day, which equals 625 μg/day. 1
Dosing Guidelines for G-CSF
Standard Dosing
- The recommended dose for G-CSF (filgrastim) in adults is 5 μg/kg/day for all clinical settings except peripheral blood progenitor cell (PBPC) mobilization 1
- For a 125kg patient, this would calculate to 625 μg/day
- The preferred route of administration is subcutaneous 1
- Rounding to the nearest vial size is an appropriate strategy to maximize cost benefit without clinical detriment 1
Special Clinical Situations
- For peripheral blood progenitor cell (PBPC) mobilization, a higher dose of 10 μg/kg/day may be preferable 1
- For autologous stem-cell transplantation, the recommended dose remains 5 μg/kg/day 1
- For allogeneic PBPC donation, a dose of 10 μg/kg/day for 7-10 days before apheresis is recommended 1
Pegfilgrastim Alternative
- If using pegfilgrastim instead of filgrastim, the standard fixed dose is 6 mg administered once per chemotherapy cycle 1
- Pegfilgrastim should be administered 1-3 days after completion of chemotherapy 1
- The 6 mg fixed dose formulation of pegfilgrastim should not be used in patients weighing less than 45 kg 1
- For a 125kg patient, the standard 6 mg fixed dose of pegfilgrastim is appropriate 1
Administration Guidelines
Timing of Administration
- G-CSF should be started 24-72 hours after administration of myelotoxic chemotherapy 1
- In high-dose therapy with autologous stem-cell rescue, G-CSF can be given between 24-120 hours after administration of high-dose therapy 1
- G-CSF should be continued until reaching an absolute neutrophil count (ANC) of at least 2-3 × 10^9/L 1
Duration of Therapy
- Continue G-CSF until the absolute neutrophil count reaches 2-3 × 10^9/L 1
- For PBPC mobilization, G-CSF should be started at least 4 days before the first leukapheresis procedure and continued until the last leukapheresis 1
Clinical Considerations
Efficacy Across G-CSF Products
- Filgrastim, filgrastim-sndz, tbo-filgrastim, and pegfilgrastim are all effective for the prevention of treatment-related febrile neutropenia 1
- The choice between these agents depends on convenience, cost, and the specific clinical situation 1
Potential Side Effects
- Common side effects include bone pain, which may be more pronounced at higher doses 1
- At very high doses (64 μg/kg/day of GM-CSF), edema and thrombi around central venous catheters have been reported 2
- For patients with certain malignancies, particularly pediatric ALL, there may be concerns about the risk of secondary myeloid leukemia or myelodysplastic syndrome with long-term G-CSF use 1
Important Caveats
- Weight-based dosing at 5 μg/kg/day remains the standard recommendation even for patients with high body weight 1
- There is no evidence supporting dose capping for obese patients in the guidelines 1
- Alternative dosing schedules with less frequent administration have been studied but are not currently recommended in guidelines for routine use 1
- The subcutaneous route is preferred over intravenous administration based on pharmacokinetic advantages 1