Peg-Grafeel and Neulastim — One Injection Per Chemotherapy Cycle
If you have been given Peg-Grafeel or Neulastim, it is a growth factor injection designed to protect your white blood cell count after chemotherapy. The reason it is one injection and not several is that it lasts longer than the daily version.
Medically reviewed by Dr. Bharati Devi Gorantla, Medical Oncologist, MBBS · MD · DM (Adyar, Chennai) · ECMO · MRCP SCE (UK) · Last reviewed September 2026
- One injection per cycle — Pegfilgrastim is long-acting — one dose does the work of multiple daily growth factor shots.
- Not a cancer treatment — It protects your white blood cells so chemotherapy can continue on schedule.
- Timing is set by your team — It is given on a specific day after your infusion, not on the same day as chemotherapy.
- Bone pain is common and manageable — Tell your team if it is bothering you — it can usually be eased without stopping the medicine.
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Peg-Grafeel and Neulastim contain pegfilgrastim, a long-acting growth factor that tells your bone marrow to make more infection-fighting white blood cells after chemotherapy. One injection per cycle is the key difference from the daily version of the same medicine. Your oncologist prescribes it when your chemotherapy regimen carries a meaningful risk of lowering your white cell count.
What is pegfilgrastim and why is one injection enough?
Pegfilgrastim, the medicine in both Peg-Grafeel and Neulastim, is a growth factor — a protein that signals your bone marrow to produce more neutrophils, the white blood cells that protect you from infection.
The shorter-acting version of the same medicine, filgrastim, requires multiple injections after each chemotherapy cycle. Pegfilgrastim has been chemically modified to stay in the body far longer, so one injection per cycle achieves the same protective effect.
The injection is given on a specific day after your chemotherapy infusion, not on the same day. The timing is built into your treatment schedule for a reason. If your appointment day needs to change, contact your team before rescheduling it.
Bone ache — most often in the back, hips or legs — is the most commonly reported side effect. It happens because your bone marrow is producing cells more actively than usual. It generally settles, but tell your team if it is severe or not improving.
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Did you know?
Febrile neutropenia — fever during a period of very low white blood cell count — is one of the most common reasons a planned chemotherapy cycle is delayed or a dose is reduced. Growth factors like pegfilgrastim are prescribed specifically to lower that risk when the regimen carries it.
Keeping your chemotherapy on schedule is one of the goals your oncologist is managing alongside the treatment itself.
Source: NCCN Clinical Practice Guidelines in Oncology: Hematopoietic Growth Factors
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Frequently asked questions
Is one injection really enough for the full chemotherapy cycle?
Yes. Pegfilgrastim is designed to last the full period between cycles. The 'peg' in its name refers to a molecule — polyethylene glycol — attached to the base medicine to slow how quickly the body clears it, keeping it active for longer than the daily version. Whether one injection is the right approach for your specific regimen is a clinical decision your oncologist has already made when prescribing it.
What is the difference between Peg-Grafeel, Neulastim and Neulasta?
All three contain pegfilgrastim — the same active medicine — and work in the same way. Neulasta is the original brand. Peg-Grafeel and Neulastim are biosimilars: versions of the same biological medicine made by different manufacturers and approved by regulators as equivalent to the original. The clinical effect is the same. Your team may prescribe whichever is available and appropriate for your situation.
How much does a pegfilgrastim injection cost in India?
Pegfilgrastim is among the higher-cost supportive medicines in cancer care, though the total outlay across a cycle may compare favourably with daily filgrastim injections once clinic visits are factored in. Biosimilar brands like Peg-Grafeel and Neulastim are generally priced below the original. Costs are indicative, vary by centre and change over time — your treatment coordinator is the right person to ask for the current figure for your specific situation.
Why is the injection given on a different day from my chemotherapy?
Giving pegfilgrastim on the same day as chemotherapy risks stimulating production of blood cells that the chemotherapy then damages, which reduces the protective effect. There is a specific gap your team follows based on your regimen, and that gap is built into your prescription. If the day of your injection appointment needs to change, contact your team first rather than rescheduling it independently.
I had bone pain after the injection — is that dangerous?
Bone pain, most commonly in the back, hips or legs, is the most frequently reported side effect of pegfilgrastim and is caused by your bone marrow working more actively than usual. It is not a sign that something has gone wrong. It generally settles as the medicine's effect reduces over the cycle. Tell your team at your next visit, or sooner if the pain is severe, is stopping you from sleeping or is getting worse rather than better — they can advise whether anything will help.
What if I miss the appointment for my growth factor injection?
Contact your oncology team the same day. The timing window for giving pegfilgrastim is specific to your regimen, and your team can advise whether it can still be given or what needs to happen for this cycle. Missing it without checking is not a safe option — the protection it provides is timed around how your white cell count falls and recovers after chemotherapy.
Will I need this injection every cycle?
In most cases, yes — if pegfilgrastim is part of your regimen, you will receive it each cycle unless your team decides otherwise. Decisions about continuing are made based on how your blood counts are recovering, how you are tolerating the medicine and whether your regimen changes. Your oncologist will tell you if anything changes from cycle to cycle. It is not something to stop or skip without checking first.
Can I have this injection at CION as a day visit?
Yes. Growth factor injections are given as day care at CION centres — you do not need to be admitted overnight. The specific day you come in for your injection is planned as part of your overall chemotherapy schedule and will be confirmed when your cycle is arranged.
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