{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T13:56:07Z","timestamp":1781877367890,"version":"3.54.5"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T00:00:00Z","timestamp":1780876800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>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\u2005mg\/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\u2005\u03bcg\/kg) without any adverse events during the first two chemotherapy cycles. Within two hours post-injection, she exhibited severe hypotension (74\/52 mmHg), hypoxemia (SpO\u2082 81%), and marked leukocytosis (55.32 \u2192 104.25\u2009\u00d7\u200910\u2079\/L within 24\u2005h). Emergency intervention with epinephrine and dexamethasone resolved the symptoms. Peripheral blood analysis revealed eosinophilia (0.16\u2009\u00d7\u200910\u2079\/L), suggesting drug sensitization. During the fourth chemotherapy cycle, subcutaneous recombinant human G-CSF (rhG-CSF, filgrastim biosimilar; 5\u2005\u03bcg\/kg) was administered, but the patient experienced a nearly identical reaction within 30\u2005min (BP 53\/29 mmHg, SpO\u2082 97%). The temporal correlation and clinical consistency confirmed a G-CSF-induced systemic hypersensitivity reaction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2026.1749442","type":"journal-article","created":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T04:22:50Z","timestamp":1780892570000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Granulocyte colony-stimulating factor-induced hypersensitivity reaction with leukocytosis in a pediatric germ cell tumor patient: a case report"],"prefix":"10.3389","volume":"14","author":[{"given":"Yuhui","family":"Tan","sequence":"first","affiliation":[{"name":"Department of Pharmacy, Xichang People's Hospital","place":["Xichang, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chaoyong","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Xichang People's Hospital","place":["Xichang, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenyan","family":"Xiao","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Xichang People's Hospital","place":["Xichang, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yilan","family":"Fu","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Hunan Cancer Hospital","place":["Changsha, Hunan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xi","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Xichang People's Hospital","place":["Xichang, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanxiang","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Gynecological Oncology, Hunan Cancer Hospital","place":["Changsha, Hunan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Changli","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Xichang People's Hospital","place":["Xichang, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,8]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"6089","DOI":"10.3390\/ijerph20126089","article-title":"Clinical challenges in the management of malignant ovarian germ cell tumours","volume":"20","author":"Saani","year":"2023","journal-title":"Int J Environ Res Public Health"},{"key":"B2","doi-asserted-by":"publisher","first-page":"e108","DOI":"10.3802\/jgo.2025.36.e108","article-title":"Malignant germ cells tumor of the ovary","volume":"36","author":"De Maria","year":"2025","journal-title":"J Gynecol Oncol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"S189","DOI":"10.1093\/clinids\/18.Supplement_2.S189","article-title":"Reduction by granulocyte colony-stimulating factor of fever and neutropenia induced by chemotherapy in patients with small-cell lung cancer","volume":"18","author":"Crawford","year":"1994","journal-title":"Clin Infect Dis"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1907","DOI":"10.1182\/blood.V88.6.1907.bloodjournal8861907","article-title":"Filgrastim (r-metHuG-CSF): the first 10 years","volume":"88","author":"Welte","year":"1996","journal-title":"Blood"},{"key":"B5","doi-asserted-by":"publisher","first-page":"103193","DOI":"10.1016\/j.critrevonc.2020.103193","article-title":"Side effects of using granulocyte-colony stimulating factors as prophylaxis of febrile neutropenia in cancer patients: a systematic review","volume":"157","author":"Lapidari","year":"2021","journal-title":"Crit Rev Oncol Hematol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1419369","DOI":"10.3389\/fphar.2024.1419369","article-title":"Efficacy, safety, and cost-effectiveness of pegylated PEG-rhg-CSF in pediatric patients receiving high-intensity chemotherapy: results from a phase II study","volume":"15","author":"Huang","year":"2024","journal-title":"Front Pharmacol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"659","DOI":"10.1200\/GO.20.00578","article-title":"The golden hour: sustainability and clinical outcomes of adequate time to antibiotic administration in children with cancer and febrile neutropenia in northwestern Mexico","volume":"7","author":"Gonzalez","year":"2021","journal-title":"JCO Glob Oncol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1038\/bmt.2008.438","article-title":"Severe allergic reaction with anaphylaxis to G-CSF (lenograstim) in a healthy donor","volume":"44","author":"Tulpule","year":"2009","journal-title":"Bone Marrow Transplant. 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