ArticleFrontiers in pediatrics2026
Granulocyte colony-stimulating factor-induced hypersensitivity reaction with leukocytosis in a pediatric germ cell tumor patient: a case report.
Article in Frontiers in pediatrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Chemotherapy-induced bone marrow suppression significantly increases the risk of febrile neutropenia (FN) in cancer patients. Granulocyte colony-stimulating factor (G-CSF) is a cornerstone therapy for FN prophylaxis and treatment that promotes myeloid progenitor cell proliferation and differentiation, thereby reducing the duration of neutropenia. While G-CSF is generally well tolerated and has a favorable safety profile, rare but life-threatening adverse events may occur. Case presentation: We present the case of a 14-year-old female with a germ cell tumor who developed a systemic hypersensitivity reaction following prophylactic administration of efbemalenograstim alfa-vuxw (20 mg/dose) after her third chemotherapy cycle. Notably, the patient had previously tolerated two full doses of efbemalenograstim alfa-vuxw and one full dose of short-acting G-CSF (filgrastim biosimilar 5 μg/kg) without any adverse events during the first two chemotherapy cycles. Within two hours post-injection, she exhibited severe hypotension (74/52 mmHg), hypoxemia (SpO₂ 81%), and marked leukocytosis (55.32 → 104.25 × 10⁹/L within 24 h). Emergency intervention with epinephrine and dexamethasone resolved the symptoms. Peripheral blood analysis revealed eosinophilia (0.16 × 10⁹/L), suggesting drug sensitization. During the fourth chemotherapy cycle, subcutaneous recombinant human G-CSF (rhG-CSF, filgrastim biosimilar; 5 μg/kg) was administered, but the patient experienced a nearly identical reaction within 30 min (BP 53/29 mmHg, SpO₂ 97%). The temporal correlation and clinical consistency confirmed a G-CSF-induced systemic hypersensitivity reaction. Conclusion: To our knowledge, this represents the first documented pediatric case of recurrent systemic hypersensitivity reactions induced by sequential administration of different G-CSF formulations following chemotherapy. Notably, long-acting G-CSF (efbemalenograstim alfa-vuxw) was associated with both hypersensitivity and pronounced leukocytosis. Our findings highlight the following: 1. Hypersensitivity to G-CSF, although rare, requires heightened clinical vigilance; 2. The Substitution of G-CSF products may not preclude recurrent reactions; 3. The safety profile and optimal dosing of efbemalenograstim alfa-vuxw in pediatric populations warrant further validation in controlled trials.
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