The complete guide to G-CSF injections

G-CSF or 'granulocyte-colony stimulating factor' is a naturally occurring hormone in your body that causes your stem cells to be released into your blood stream from your bone marrow.

For a PBSC donation, we give you a synthetic version of this hormone to promote your body to produce excess stem cells which are then collected via the blood steam at your donation.

You will need to have a daily course of injections on each of the four days leading up to your PBSC donation.

Your daily dose depends on your body weight, each donor will have a slightly different prescription, but it is always between 1 and 3 injections each day and they should be given altogether.

Ideally you will have the injections at the same time each day and we recommend having them early evening so that your last injections are closer to the start of your donation, and also so you may sleep through any side effects. However, this time of day is not essential, it depends what works best for you.

The G-CSF medication is pre-filled syringes. There are two sizes of syringes, or vials as they are commonly referred to

• 48 mu (sometimes written 480 mcg)
• 30 mu (sometimes written 300 mcg)

An example of the G-CSF syringes are below, we will advise you of your dose ahead of your injections beginning.

You will either be given it at your medical or it will be couriered to your home address approx. 3-7 days before you start your injections. Once you receive it the G-CSF should stay in the outer packaging, to protect it from light, and must be kept in the fridge (2°C - 8°C) until you use it. Once it is taken out of the fridge it can be stored at room temperature for a max. of 8 days until used.

There are three different routes that donors can follow to have their G-CSF injections:

Donor administration (most common) - either you or a family member/friend administers the full course  (all four days) by following our detailed instructions.

Donor administration with nurse training - a nurse visits you on the first day to train you or a family member/friend and you then administer the following three days of injections yourself.

Nurse administration visits - a nurse visits you each day for four days to administer the injections for you. The most common and convenient way is for donors or a family member/friend to administer the full course of injections but you can choose whichever route you feel most comfortable with.

Every donor is different and will experience G-CSF injections differently but pretty much all donors will experience some side-effects, the most common being fatigue, bone pain and headaches. We strongly advise that you plan to take things as easy as possible over the 4 days and prepare to expect side effects.

The side-effects will build up as the days go on. Due to your sternum (your breastbone) and pelvis (hip bone) being a very dense form of stem cell production, some donors can have quite strong aches and pains in the lower back and chest region, particularly by day 3 of injections. Some people will experience nausea and may actually vomit, and some may have difficulty sleeping.

The side effects may prevent you from doing your usual activities and we recommend avoiding heavy exercise and drinking alcohol during this time. It’s really important to try and stay well hydrated and rest as much as possible.

If your job is strenuous and you are concerned you can’t/ won’t be able to work as normal let your coordinator know - we can help cover loss of earnings so you can take time off.

Ideally you can have the injections at the same time each day as this can help to  reduce the side effects and also produce more stem cells. We recommend doing them early evening so you may sleep through any side effects and so that your last injections are closer to the start of your donation, but this is not essential.

Your symptoms should start to ease as soon as your donation starts.

Try taking paracetamol first - 2x500mg tablets up to 4 times over 24 hours, waiting 4 hours between doses – to see if it relieves your symptoms.

If you need something stronger you can alternate with ibuprofen – 2x200mg tablets up to 3 times over 24 hours, waiting 6 hours between doses. However, you can only take ibuprofen on days 1-3 of G-CSF, not on day 4 as ibuprofen cannot be taken within 24 hours of your donation.

You must not take aspirin at any point whilst having G-CSF as it can stay in your system and affect platelet function for 7 days.

If paracetamol and/or ibuprofen are not managing your pain, please contact us. You can also obtain co-codamol, which is available from pharmacies without a prescription. The over-the-counter dose contains 8 mg of codeine and 500 mg of paracetamol per tablet. You can take 1–2 tablets every 4–6 hours as needed, but do not take more than 8 tablets in 24 hours. Please do not take co-codamol at the same time as paracetamol.

If you want to talk to someone about your G-CSF injections, any side effects or about anything to do with your donation:

1. Call your coordinator on their direct line (see their email signature)
2. Call the Donor Provision team line on 020 7424 6699
3. Call the Donor Provision 24-hour emergency line on 07710 599161

A sharps bin will be delivered/given to you along with the G-CSF syringes.

This will either be collected 7 - 14 days after your donation or you can bring it to your PBSC donation.

You can either have your final injections before you fly, or we can provide a letter for you, signed by our medical team, which allows you to travel with the injections. You can then dispose of your sharps bin at the collection centre when you go to your donation.

Key things to know

• You need a family member/friend to be with you on day 1 and they must be able to stay with you on for at least an hour after the first injection/s. If this is not going to be possible let your coordinator know asap. 
• If a family member or friend is administering for you, they must be aged 18 or over and they need to be available at the same time each day for the 4 days.
• Only start your injections on day 1 if you are feeling well. If you have been asked to do a  pregnancy test you need to do this first and message your coordinator with the negative result.
  • Contact your coordinator (or call 07710 599161) if you feel unwell or if you get a positive pregnancy test.
• Do your injections at roughly the same time each day. If you want to check your daily dosage do not hesitate to contact your coordinator or call our emergency number.

• Ruptured spleen: If G-CSF makes the spleen very large, there is a risk that this may rupture. This is extremely rare in healthy donors, but it has been documented in case reports. The risk is estimated to be between 1 in 5000 and 1 in 10,000 and it is thought to be related to increased number of days and dose of G-CSF. For this reason, all donors undergo medical examination to assess the size of their spleen before starting the process, we give an absolute maximum of 5 days of G-CSF and we use a dose of 10mcg/kg. If at any point you notice pain or enlargement in your left upper abdomen, please contact us. Our medical officer will chat to you about it and decide if you need a scan of your abdomen.
• Acute respiratory distress syndrome (ARDS): This is an extremely rare side effect that has been reported only a few times. This happens when you develop fluid on the lung and can make you feel short of breath. The rare cases reported in the literature have sometimes been associated with previously undiagnosed infection prior to taking the G-CSF. If you develop shortness of breath contact us immediately and we will arrange for you to be reviewed.
• Serious allergic (anaphylactic) reactions: With any new medication there is always a risk of allergy in the form of an anaphylactic response. The risk of anaphylaxis with G-CSF is between 1 in 1000 and 1 in 10,000. You must have someone with you when administering your first dose(s) of G-CSF on day 1 and you/they must call 999 in the very unlikely event of symptoms of anaphylaxis.
• Kidney injury and capillary leak syndrome: Another extremely rare side effect is a change in your kidney function. This is why we always assess the kidney function at medical including checking urine for blood and protein. There is the rare possibility of G-CSF unmasking pre-existing health conditions, such as IgA nephropathy, and therefore care is taken to screen donors for this at medical.

The long-term side effects of G-CSF are closely monitored by Anthony Nolan and registries around the world, by following up donors for 10 years after donation with regular questionnaires. In a global study of over 27,000 donors, no differences were found between stem cell donors and the general public in terms of reporting malignancies or other long-term health problems in this follow-up period.

We also make sure all our donors have a full medical check before donating in order to minimise the risk of any long-term side-effects.