Role of Granulocyte-Colony Stimulating Factor (G-CSF) in Febrile Neutropenia among Pediatric Cancer Patients in Resource-Limited Settings

Abstract

Background: Chemotherapy-induced Febrile neutropenia (FN) is a potentially catastrophic complication in childhood cancer, requiring urgent management and hospitalization, with a heightened risk of mortality. Granulocyte-colony stimulating factors (G-CSFs) are used both prophylactically to decrease FN episodes and therapeutically during febrile neutropenia. However, evidence supporting their role in resource-limited settings remains scarce. Objectives: To evaluate the effect of granulocyte colony-stimulating factor on hospital stay duration, treatment cost, and mortality among children suffering from febrile neutropenia. Methodology: This prospective cohort study enrolled 250 children with chemotherapy-induced FN at the Children’s Hospital Lahore (CHL) from September 2018 to December 2018. Patients received G-CSF (filgrastim, 10 mcg/kg/day for five days or until ANC >1000 for two consecutive days), primarily in the solid malignancy group. Clinical characteristics, neutrophil counts, hospital stay, treatment costs, and outcomes were recorded. Data were analyzed using SPSS 23.  Results: G-CSF significantly decreased hospital stay (p = 0.048) and was administered more frequently in instances of severe neutropenia (ANC < 100x10³/µL in 82% of cases, p = 0.000). Mortality in the G-CSF group was 3%, though not statistically significant (p = 0.147). In clinical settings, G-CSF improved hematological recovery in solid malignancies and was cost-effective (p = 0.027). Conclusion: G-CSF demonstrated superior clinical efficacy compared to intravenous antibiotics alone by reducing hospitalization and neutropenia severity, without imposing a substantial cost burden. These findings support G-CSF as a desirable FN management strategy, even in low-resource pediatric oncology centers.