More and more tumors have started concurrent radiotherapy. While the therapeutic efficacy has been improved, the toxic side effects of concurrent radiotherapy have also attracted more and more attention, especially the myelosuppression as a toxic side effect. Wang Wei, Department of Breast Surgery, The First Affiliated Hospital of Henan College of Traditional Chinese Medicine In the clinic, it is often observed that due to the myelotoxicity of radiotherapy, the white blood cells of patients are still very low at the expiration of chemotherapy, and the granulocyte colony-stimulating factor (GCSF) can be raised up. However, the question that arises is: can chemotherapy be given immediately after GCSF raises the white blood cells? Some people say that we should rest for 48 hours and review the results, and if they are normal, we can treat the patient with chemotherapy. However, after 48 hours, the white blood cells of many patients have dropped again, so the white blood cells have to be raised again, and chemotherapy has been postponed again and again. This article describes the timing of the use of GCSF, dosing time and precautions. First, whether the prophylactic use of GCSF before chemotherapy ASCO guidelines: non-primary patients prophylactic use of GCSF is only used for the last course of treatment (not prophylactic use of GCFS) after the emergence of granulocyte deficiency comorbidities (eg, fever) and the reduction of the dosage may affect the efficacy of the patient. NCCN Guidelines: risk of granulocyte deficiency >20% is high risk and requires prophylaxis with GCFS. risk is 10%-20% and is intermediate risk for consideration. See NCCN guidelines for specific evaluation criteria. As patients who have developed granulocyte deficiency comorbidities have a 50%-60% reoccurrence rate after the next chemotherapy. Prophylactic use of GCFS reduces the risk by 50%. In conclusion, patients with solid tumors in general, who have not experienced granulocyte comorbidity and do not have risk factors, do not use GCFS prophylactically. II. Timing of GCFS for chemotherapy A number of literature reports that the best time to start GCFS is 24-48 hours after chemotherapy. Stop the drug before the next chemotherapy and try not to use it on the day of chemotherapy. The elevation of leukocytes after the application of GCFS is bimodal: the first peak is 2-3 days after the application of GCFS, then decreases to the lowest level in 5-6 days, and then rises again and reaches the second peak in 8-9 days. The first peak was the result of GCFS promoting the release of mature granulocytes already present in the bone marrow blood pool to the periphery. The second peak is the result of GCFS stimulating the proliferation and differentiation of bone marrow granulopoietic progenitor cells to mature and release into the para-peripheral blood. Duration of administration Not less than 3 days. Too short a period of time can only cause the first peak, and stopping the drug white blood cells tend to fall to the lowest point and easy to appear infection, fever. Why can’t it be used on the same day of chemotherapy? The neutrophils produced by stimulation will be destroyed by chemotherapeutic drugs, which will aggravate their damage to the bone marrow reserve function and increase the risk of moderate myelosuppression. Fourth, toxic side effects Localized pain, fatigue, fever, muscle aches and pains. Patient education and explanation should be done in advance. V. Precautions 1. Review the blood routine in time and adjust the treatment plan Generally speaking, chemotherapy can be given after the blood check is normal 24 hours after the ascending white. After 24 hours after the end of the first cycle of chemotherapy, it is necessary to routinely prevent the rise of white blood cells for three days, and then review the blood routine, according to the results of the review to consider continuing to raise the white or a week later to review the blood routine again. If after the first cycle of chemotherapy to prevent white blood cell elevation, the second cycle of chemotherapy to hit the second cycle of pre-check blood routine is still IV degree of myelosuppression, then the subsequent chemotherapy should be given in accordance with 75% of the original dose. If there is granulocyte deficiency fever, then the next cycle of chemotherapy should be given after preventing leukocyte elevation. 2. The use of mushroom polysaccharide It has been reported in the literature that mushroom polysaccharide is beneficial to improving the hematopoietic function of bone marrow, and its specification says that it occasionally reduces red and white blood cells and hemoglobin, which indicates that mushroom polysaccharide has very little inhibition on the blood system. 3. Fill in the patient’s discharge record and precautions carefully and in detail. The discharge precautions should clearly state which day the white blood cells will start to rise, how many days the white blood cells will rise, and which day the blood will be checked, and the patient should report the results to the physician in a timely manner. If it is only verbalized which day to start raising white blood cells, the patient’s compliance is very poor, and when the occurrence of IV degree of myelosuppression will be too late. In addition, the discharge summary must state that the patient is not suitable for follow-up.