Congenital Neutropenia

• Starting dose ~5 mcg/kg/day subcutaneously daily. IV is also acceptable but may be less effective.

• Assess response after 7-10 days to allow time for maturation from promyelocyte arrest. Blood counts should be obtained at least 18 hours after last dose.

• Titrate dose to maintain ANC >1000 cells/μL. Higher doses may be necessary if clinical symptoms (e.g. severe stomatitis) persist.

• If the response warrants, administration may be switched to alternate day or Mon-Wed-Fri, but less frequent administration may lead to more bone pain and less efficacy. Check ANC in two weeks at nadir before a dose.

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Cyclic Neutropenia

• Starting dose ~2 mcg/kg/day subcutaneously daily. Alternate day or Mon-Wed-Fri administration is usually effective, but daily may be necessary

• Monitoring ANC response is difficult, requiring CBCs three times per week for 3 weeks. Doses may also be adjusted based on elimination of symptoms (e.g. mouth sores, fevers, malaise)

• We do NOT recommend trying to time the nadirs with intermittent administration, as the cycling period is diminished and may be irregular with G-CSF treatment.

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Idiopathic/Autoimmune Neutropenia

• Starting dose 1-2 mcg/kg/day subcutaneously daily.

• Assess response after 7-10 days. Blood counts should be obtained at least 18 hours after last dose.

• Titrate dose to maintain ANC >1000 cells/μL. Higher doses may be necessary if clinical symptoms (e.g. severe stomatitis) persist.

• If the response warrants, administration may be switched to alternate day or Mon-Wed-Fri, but less frequent administration may lead to more bone pain and less efficacy. Check ANC at nadir after 2-3 doses. If dosing Mon-Wed-Fri, then check the nadir before the Monday dose (3-day nadir).

• If infections are infrequent, administration can be restricted to times of infection, as response is usually very rapid (within hours or days).

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