Do you use G-CSF for a patient with ALL admitted for febrile neutropenia with prolonged count recovery?

I agree with this response. To highlight one other consideration: G-CSF is not routinely given during COG-based, pediatric-inspired therapy like the C10403 regimen (Stock et al., PMID 30658992). However, when patients treated with this approach in our system develop neutropenic fever, we will usually start G-CSF to hasten their neutrophil recovery and hopefully avoid more significant complications.

Acknowledging the lack of definitive data, in our group we use G-CSF as primary prophylaxis in adult patients with ALL treated with intensive chemotherapy and hardly ever need to re-administered if they develop FN subsequently. That said, for prolonged neutropenia despite prior G-CSF, we may administer additional doses on an individual basis, based on the patient's clinical circumstances. In the case that the patient did not receive GCSF prophylaxis and is admitted with FN and expected to undergo a phase of prolonged neutropenia, we usually administer GCSF to shorten the neutropenia duration.