Granulocyte Colony-Stimulating Factor-Induced Vascular Complications
Summary
Granulocyte colony-stimulating factor (G-CSF) is routinely administered to prevent or treat chemotherapy-induced neutropenia by promoting neutrophil proliferation and differentiation. While generally well tolerated, G-CSF and its long-acting formulations may provoke rare vascular complications, most notably aortitis and other forms of vasculitis. These events are believed to arise from excessive cytokine release leading to endothelial activation, inflammatory cell infiltration of vessel walls and subsequent structural changes. Clinically, affected patients present with prolonged fevers, elevated inflammatory markers and site-specific pain. Imaging typically reveals vessel wall thickening and perivascular inflammation. Management strategies range from close observation to corticosteroid therapy, with most cases resolving without long-term sequelae. Awareness of these complications is vital to differentiate them from infectious causes and to guide appropriate intervention.
Research from Nature Portfolio
Recent studies have detailed the prevalence and clinical features of pegfilgrastim-induced aortitis in large chemotherapy cohorts. In one analysis of over 2,000 patients receiving PEG-G support, the incidence of acute aortitis was approximately 0.3%. Affected individuals uniformly exhibited high-grade fevers, chest or back pain and markedly raised C-reactive protein levels in the absence of infection. Contrast-enhanced computed tomography revealed characteristic enhancing wall thickening and periaortic soft tissue infiltration. Importantly, all patients demonstrated rapid clinical and radiological improvement following moderate-dose prednisolone, underscoring the necessity of early recognition and immunomodulatory treatment.
Granulocyte Colony-Stimulating Factor-Induced Vascular Complications publication trend
The graph below shows the total number of articles in granulocyte colony-stimulating factor-induced vascular complications across all publications each year (not limited to Nature Index journals).
Technical terms
Granulocyte colony-stimulating factor (G-CSF): A haematopoietic growth factor that stimulates the production and maturation of neutrophils.
Aortitis: Inflammation of the aortic wall characterised by fever, pain and vessel wall thickening on imaging.
Pegfilgrastim: A polyethylene glycol-conjugated form of G-CSF with an extended circulation half-life.
Neutropenia: A reduction in circulating neutrophils below normal thresholds, increasing infection risk.
Corticosteroid therapy: Immunosuppressive treatment using glucocorticoids to reduce vessel wall inflammation.
References
- Balancing Benefits and Risks: A Literature Review on Hypersensitivity Reactions to Human G-CSF (Granulocyte Colony-Stimulating Factor). International Journal of Molecular Sciences (2024).
- Granulocyte-colony stimulating factor-associated aortitis in a woman with advanced breast cancer: a case report and review of the literature. BMC Cancer (2019).
- The incidence and clinical features of PEGylated filgrastim-induced acute aortitis in patients with breast cancer. Scientific Reports (2020).
- Drug-induced aortitis of the subclavian artery caused by pegfilgrastim: a case report. Surgical Case Reports (2021).
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