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After cycle four she developed neutropenic fever and received sargramostim (granulocyte-macrophage colony-stimulating factor) under intensive premedication and intensive care monitoring, which she initially tolerated; on the third administration she developed anaphylaxis requiring epinephrine. She completed all six cycles of R-CHOP without growth factor support, using prophylactic antibiotics and close monitoring, achieved complete remission and remains disease-free 41 months after treatment. To our knowledge, this is the second documented case of anaphylaxis to agents from both the granulocyte colony-stimulating factor and granulocyte-macrophage colony-stimulating factor classes in one patient, and the first involving pegfilgrastim.<\/jats:p>","DOI":"10.1136\/bcr-2026-274279","type":"journal-article","created":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T13:55:28Z","timestamp":1790258128000},"page":"e274279","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Anaphylaxis to both pegfilgrastim and sargramostim in a patient with diffuse large B-cell lymphoma"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3419-2173","authenticated-orcid":false,"given":"Mohamed M","family":"Khamis","sequence":"first","affiliation":[{"name":"Department of Medicine, Mercy Hospital St Louis, St. Louis, Missouri, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John W","family":"Finnie","sequence":"additional","affiliation":[{"name":"Department of Hematology\/Oncology, Mercy Hospital St. Louis, St Louis, Missouri, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,24]]},"reference":[{"key":"2026092406552181000_19.9.e274279.1","doi-asserted-by":"crossref","DOI":"10.3390\/ijms25094807","article-title":"Balancing Benefits and Risks: A Literature Review on Hypersensitivity Reactions to Human G-CSF (Granulocyte Colony-Stimulating Factor)","volume":"25","author":"Bumb\u0103cea","year":"2024","journal-title":"Int J Mol Sci"},{"key":"2026092406552181000_19.9.e274279.2","doi-asserted-by":"publisher","DOI":"10.6004\/jnccn.2017.0175"},{"key":"2026092406552181000_19.9.e274279.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2009.10.060"},{"key":"2026092406552181000_19.9.e274279.4","doi-asserted-by":"crossref","DOI":"10.1016\/j.waojou.2024.100876","article-title":"Updated grading system for systemic allergic reactions: Joint Statement of the World Allergy Organization Anaphylaxis Committee and Allergen Immunotherapy Committee","volume":"17","author":"Turner","year":"2024","journal-title":"World Allergy Organ J"},{"key":"2026092406552181000_19.9.e274279.5","doi-asserted-by":"publisher","DOI":"10.1016\/S1081-1206(10)62867-0"},{"key":"2026092406552181000_19.9.e274279.6","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1016\/S1081-1206(10)63273-5","article-title":"Immediate hypersensitivity to human recombinant granulocyte-macrophage colony-stimulating factor associated with a positive prick skin test reaction","volume":"76","author":"Engler","year":"1996","journal-title":"Ann Allergy Asthma Immunol"},{"key":"2026092406552181000_19.9.e274279.7","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199207023270106"},{"key":"2026092406552181000_19.9.e274279.8","doi-asserted-by":"publisher","DOI":"10.1016\/0268-960X(92)90007-D"},{"key":"2026092406552181000_19.9.e274279.9","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1177\/10781552221112323","article-title":"Anaphylaxis caused by pegylated recombinant human granulocyte colony-stimulating factor","volume":"29","author":"Chen","year":"2023","journal-title":"J Oncol Pharm Pract"},{"key":"2026092406552181000_19.9.e274279.10","doi-asserted-by":"crossref","first-page":"624","DOI":"10.1016\/j.clinthera.2025.04.017","article-title":"Comparative Analysis of Adverse Events Linked to PEG-rhG-CSF and rhG-CSF in Real-World Settings: Disproportionate Examination of the US Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) Database","volume":"47","author":"Qu","year":"2025","journal-title":"Clin Ther"},{"key":"2026092406552181000_19.9.e274279.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2020.01.017"},{"key":"2026092406552181000_19.9.e274279.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2005.12.1303"},{"key":"2026092406552181000_19.9.e274279.13","first-page":"495","article-title":"Anaphylaxis associated with relative bradycardia","volume":"62","author":"Simon","year":"1989","journal-title":"Ann Allergy"},{"key":"2026092406552181000_19.9.e274279.14","doi-asserted-by":"publisher","DOI":"10.1097\/01.all.0000174158.78626.35"},{"key":"2026092406552181000_19.9.e274279.15","unstructured":"Amgen Inc . 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