Anaphylaxis from filgrastim prophylaxis within the same day of chemotherapy: A case report

Filgrastim is recommended to be used 24–72 h after the last dose of chemotherapy for the prophylaxis of febrile neutropenia. However, several studies demonstrate the efficacy and safety of the use of filgrastim within the same day of the last dose of chemotherapy. We presented a patient with state IIIC immature teratoma at her right ovary who was treated with the BEP regimen. She received 10 doses of filgrastim per BEP cycle to prevent febrile neutropenia. On the first BEP cycle, the first dose of filgrastim was used within 24 h after the last chemotherapy dose and dyspnea was developed. On the second cycle of BEP, filgrastim was still used as the same-day regimen. One hour after the first dose of filgrastim, anaphylaxis occurred and the patient was treated appropriately. The second dose of filgrastim can be rechallenged successfully and filgrastim can be finished without any adverse events. On the third and fourth cycles of BEP, filgrastim was used as the next-day regimen (interval longer than 24 h). There were no adverse events that occurred during the use of filgrastim. The residual chemotherapy may increase the risk of anaphylaxis induced by filgrastim via a non-IgE-mediated mechanism in this case patient.