American Society of Hematology-American Society of Pediatric Hematology/Oncology

View all recommendations from this society

Released December 9, 2019

Don’t routinely administer granulocyte colony stimulating factor (G-CSF) for empiric treatment of pediatric patients with asymptomatic autoimmune neutropenia in the absence of recurrent or severe bacterial and/or fungal infections.

In pediatric patients with asymptomatic autoimmune neutropenia, there is insufficient evidence to support the routine use of granulocyte colony stimulating factor (G-CSF) as a prophylaxis strategy to improve health outcomes. The use of G-CSF in this population should be guided by clinical evaluation. The unnecessary routine use of G-CSF could lead to intolerable side effects, such as bone pain, as well as avoidable healthcare cost.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The American Society of Hematology (ASH) and the American Society of Pediatric Hematology/Oncology (ASPHO) formed a task force to solicit, evaluate, and select list items for a pediatric focused Choosing Wisely list.  The panel was composed of 13 members – two co-chairs (representing ASH and ASPHO), five members selected by each organization, and one member serving as an advisor on Choosing Wisely methodology.  Suggestions were solicited from the membership of both societies.  Formal systematic reviews of the evidence were completed for eight semi-finalist items.  Final item selections were made by the ASH-ASPHO CW task force with reference to the following six guiding principles: avoiding harm to patients, producing evidence-based recommendations, considering both the cost and frequency of tests and treatments, making recommendations in the clinical purview of the hematologist, and considering the potential impact of recommendations. Harm avoidance was established as the campaign’s preeminent guiding principle.


Fioredda F, Calvillo M, Bonanomi S, Coliva T, Tucci F, Farruggia P, Pillon M, Martire B, Ghilardi R, Ramenghi U, Renga D, Menna G, Pusiol A, Barone A, Gambineri E, Palazzi G, Casazza G, Lanciotti M, Dufour C. Congenital and acquired neutropenias consensus guidelines on therapy and follow‐up in childhood from the Neutropenia Committee of the Marrow Failure Syndrome Group of the AIEOP (Associazione Italiana Emato‐Oncologia Pediatrica). American Journal of Hematology. 2012 Feb;87(2):238-243.