Filgrastim (Grafeel, Neukine) — Injections for Low White Cell Count
Grafeel and Neukine (filgrastim) are given after chemotherapy to stop your white blood cell count from staying dangerously low. The bone pain they cause is real, often severe, and almost never explained before the first dose. This page covers what the injection is for and what to do when it hurts.
Medically reviewed by Dr. Bharati Devi Gorantla, Medical Oncologist, MBBS · MD · DM (Adyar, Chennai) · ECMO · MRCP SCE (UK) · Last reviewed September 2026
- Raises white cell counts after chemotherapy — Low counts after chemo leave you at serious risk of infection. Filgrastim cuts the time your counts stay dangerously low.
- Bone pain is common — and often severe — Most people are not warned beforehand. It comes from inside the marrow, which means the medicine is working.
- Injected under the skin, at home or in clinic — Common sites are the abdomen, outer thigh, or upper arm. Families can be trained to give it at home.
- Always ask your team before taking pain relief — Not all pain medicines are safe during cancer treatment. Your team will advise which ones are right for you.
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Grafeel and Neukine are brand names for filgrastim, a medicine that tells your bone marrow to make white blood cells faster after chemotherapy. It is given as an injection under the skin. The most common side effect is bone pain — sometimes severe — because your marrow is being pushed to work harder than usual.
Why does a white cell injection cause such severe bone pain?
The pain comes from inside the bone marrow itself. Filgrastim — the medicine in Grafeel and Neukine — is given after chemotherapy to raise white blood cell counts, and it does this by signalling the marrow to produce cells faster than usual.
That rapid activity causes the marrow to expand inside bone, creating pressure. The result is aching, throbbing, or sharp pain in the lower back, hips, sternum, and long bones. It can be intense. Most patients are given no warning before their first dose.
Tell your treating team before you take anything for the pain. Not all pain medicines are safe alongside your cancer treatment, and your team can tell you which ones are right for you.
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Did you know?
Bone pain from filgrastim is not a sign the cancer is spreading. It comes from the bone marrow itself, which is expanding to produce more white blood cells in response to the medicine.
It is one of the most undertreated side effects in cancer supportive care — not because it cannot be managed, but because patients are rarely warned it is coming. Tell your team when it starts.
Source: ESMO Clinical Practice Guidelines: Use of Granulocyte-Colony Stimulating Factors
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Frequently asked questions
What is Grafeel or Neukine and why has my oncologist prescribed it?
Grafeel and Neukine are brand names for filgrastim, a medicine that raises your white blood cell count after chemotherapy. Chemotherapy can lower the count to a level where ordinary bacteria become dangerous. Filgrastim signals your bone marrow to produce new white cells faster, shortening the period your counts stay in the high-risk range. Your oncologist will tell you how it fits into your treatment plan.
Why does filgrastim cause bone pain?
Filgrastim works by pushing the bone marrow to produce more white cells than it normally would. The marrow sits inside bone, and when it becomes very active it expands. That expansion creates pressure inside a confined space. The lower back, hips, sternum, and long bones are where most people feel it most. The pain is a sign the medicine is working, not a sign anything is going wrong.
Where on the body is the injection given?
The injection goes into fatty tissue just under the skin — not into a vein or muscle. The most common sites are the lower abdomen away from the navel, the outer thigh, and the upper arm. Your nurse will show you the correct technique, how to rotate sites so one spot does not become sore, and how to dispose of the needle safely.
Can the injection be given at home?
Yes. Home administration is common once a family member has been shown the technique by your nurse. If you are not comfortable giving it at home, or the first dose is being given, ask whether it can be administered at the clinic. Your team will also explain how to store the medicine correctly before each dose.
Is the bone pain a sign the cancer is spreading to the bones?
No. The bone pain from filgrastim comes from the marrow responding to the medicine, not from the disease. That said, if the pain feels different from what you were warned about, is in a new location, or comes alongside fever, call your team the same day. Any new bone pain during cancer treatment deserves a conversation with your oncologist.
What should I do if the bone pain is very severe?
Tell your treating team before taking any pain medicine. Some medicines used for pain are not safe alongside cancer treatment, and your team knows your full medicine list. If the pain is severe enough that you cannot sleep or carry out daily activities, call the same day — do not wait for your next scheduled visit.
Are there side effects other than bone pain?
Bone pain is the most commonly reported side effect. Some people notice redness, bruising, or a small lump at the injection site, which usually settles within a day or two. A small number of people develop sudden severe pain in the upper left abdomen — this is rare but needs immediate medical attention. Report any unexpected symptoms to your team rather than assuming they are normal.
How will my doctor know the injection is working?
The most direct measure is a blood test showing your white cell count rising. Your oncologist will time these checks as part of your treatment plan. When the count recovers to a safe level, the injections are typically no longer needed for that cycle. The bone pain itself is a practical signal that the marrow is responding, but blood tests are what your team uses to decide next steps.
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