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Review Article | DOI: https://doi.org/10.31579/2690-4861/1000
Department of Internal Medicine, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France.
*Corresponding Author: Emmanuel Andres, Department of Internal Medicine, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France.
Citation: Emmanuel Andres, Noel L. Villalba, (2026), Hematopoietic Growth Factors in Idiosyncratic Drug-Induced Neutropenia: Mechanisms, Clinical Evidence, and Future Perspectives, International Journal of Clinical Case Reports and Reviews, 34(3); DOI:10.31579/2690-4861/1000
Copyright: © 2026, Emmanuel Andres. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 20 January 2026 | Accepted: 03 February 2026 | Published: 25 February 2026
Keywords: hematopoietic growth factors; granulocyte colony-stimulating factor (g-csf); idiosyncratic neutropenia; agranulocytosis; drug-induced hematologic toxicity; granulocyte macrophage colony-stimulating factor gm-csf; supportive therapy; pharmacogenomics
Idiosyncratic, non-chemotherapy drug-induced neutropenia and agranulocytosis are rare but potentially life-threatening adverse drug reactions, frequently affecting older or medically complex patients. Prompt recognition, immediate discontinuation of the causative agent, and supportive care are essential to minimize morbidity and mortality. Hematopoietic growth factors (HGF), particularly granulocyte colony-stimulating factor (G-CSF) and granulocyte macrophage colony-stimulating factor (GM-CSF), have emerged as valuable therapeutic tools, accelerating neutrophil recovery, reducing infectious complications, and improving clinical outcomes. This review synthesizes current understanding of the pathophysiology, high-risk medications, and clinical presentation of idiosyncratic neutropenia, with an emphasis on HGF pharmacology, formulations, efficacy, and safety. Limitations of the existing evidence, including the lack of prospective trials and heterogeneity in drug exposure and patient populations, are discussed. Finally, we outline future directions, including pharmacogenomic risk stratification, next-generation growth factors, and digital health strategies, highlighting opportunities to optimize individualized patient care. Integrating mechanistic insights with emerging therapeutic approaches positions HGFs as a cornerstone of management and a focus for future research in this rare but serious condition.
Idiosyncratic, non-chemotherapy-related drug-induced neutropenia and agranulocytosis are uncommon but potentially life-threatening adverse drug reactions, most often defined by an absolute neutrophil count (ANC) <0>
To date, more than 100 drugs spanning multiple therapeutic classes have been implicated. These include antibiotics (β-lactams, sulfonamides), antithyroid agents (methimazole, propylthiouracil), antipsychotics (clozapine), and antiepileptics (carbamazepine) (1, 2, 4). Limited clinical familiarity with these associations can result in delayed diagnosis and management, thereby increasing morbidity and mortality. Awareness of at-risk medications, careful monitoring and early recognition remain critical to improving outcomes.
Hematopoietic growth factors (HGFs), particularly granulocyte colony-stimulating factor (G-CSF), have been increasingly used in the treatment of severe idiosyncratic neutropenia. Observational cohorts and case series suggest that G-CSF accelerates neutrophil recovery, reduces hospital length of stay, and improves overall survival compared with supportive care alone [5–7]. However, robust prospective data are lacking. No large-scale trials have systematically addressed the optimal timing of initiation, dosing strategies, or criteria for patient selection in this context. As a result, guideline recommendations remain largely based on retrospective analyses, expert consensus, and clinical judgment [1, 2].
This review synthesizes current evidence on idiosyncratic drug-induced neutropenia and agranulocytosis, emphasizing the role of HGFs in management. We discuss pathophysiological mechanisms, highlight high-risk pharmacological classes, examine clinical outcomes, and identify critical gaps in knowledge. Addressing these gaps through prospective studies and standardized reporting will be essential to optimize early recognition, risk stratification, and therapeutic interventions, ultimately improving patient care and reducing preventable complications.
The annual incidence of severe non-chemotherapy drug-induced neutropenia or agranulocytosis is estimated at 1.6–15.4 cases per million population, with consistently higher rates observed among older adults and women [2, 8]. Although rare, this condition carries a substantial mortality risk of approximately 5–10% in hospitalized patients, highlighting its clinical significance and the critical need for prompt recognition [1, 2]. Among the most frequently implicated drugs are antithyroid agents, particularly methimazole and propylthiouracil, typically prescribed for autoimmune thyroid disorders, followed by psychotropic medications such as clozapine, levomepromazine, and carbamazepine [1, 2]. Additionally, antibiotics — notably β-lactams and trimethoprim-sulfamethoxazole — and antimalarials such as dapsone, have been repeatedly associated with idiosyncratic agranulocytosis [2, 8].
The pathogenesis is generally immune-mediated, involving drug-dependent antibodies, or arises from direct cytotoxic effects on granulocytic precursors in the bone marrow [9]. In contrast to chemotherapy-induced neutropenia, the risk is not dose-dependent, and onset may occur rapidly within days or be delayed for several weeks following exposure [1, 2]. Populations at increased risk include elderly patients, individuals with renal impairment, and those receiving multiple concomitant hematotoxic drugs. Emerging evidence also implicates genetic susceptibility, including specific HLA haplotypes and pharmacogenomic variants that influence drug metabolism and immune responsiveness [10].
Insights from large-scale epidemiological registries, such as the Berlin Case-Control Surveillance Study and French pharmacovigilance databases, have been instrumental in identifying both high-risk medications and patient-specific susceptibility factors [11, 12]. In clinical practice, immediate withdrawal of the offending drug remains the cornerstone of management. Supportive care, including broad-spectrum antibiotics and administration of G-CSF, has been shown to accelerate neutrophil recovery and reduce morbidity, underscoring the importance of timely intervention [2,7].
The mechanisms underlying non-chemotherapy drug-induced neutropenia are heterogeneous and remain incompletely understood. Most cases are considered idiosyncratic, arising from either immune-mediated destruction of neutrophils or their progenitors, or direct cytotoxic effects on hematopoietic precursors within the bone marrow [9]. According to the immune hypothesis, certain drugs or their reactive metabolites act as haptens, binding to neutrophil surface antigens or marrow-derived cells and eliciting an immune response [9, 13]. This process may culminate in the generation of antineutrophil antibodies or activation of cytotoxic T cells, resulting in peripheral neutrophil destruction or marrow aplasia.
Additional proposed mechanisms include oxidative stress and mitochondrial dysfunction induced by reactive metabolites, as exemplified by dapsone and clozapine. Direct cytotoxic effects on early myeloid progenitors have also been described, particularly with β-lactam antibiotics and sulfonamides [9]. Genetic predisposition contributes further variability, with polymorphisms in drug-metabolizing enzymes (e.g., NAT2, CYP2D6) and specific HLA alleles modulating individual susceptibility.
The latency period between drug exposure and onset of non-chemotherapy drug-induced agranulocytosis is highly variable, reflecting the diverse underlying pathways — from acute immunologic reactions with rapid onset to cumulative marrow toxicity developing over weeks to months [14]. Bone marrow examination frequently demonstrates hypocellularity with granulocytic maturation arrest, although findings may vary according to the offending agent and timing of biopsy [2]. Immune-mediated cases typically manifest as an abrupt neutrophil decline within hours to days, whereas toxic or idiosyncratic mechanisms often present more insidiously.
This mechanistic heterogeneity underscores the importance of considering multiple pathways in clinical evaluation and provides the rationale for HGF therapy, which stimulates early myeloid progenitors irrespective of the initiating insult [9, 14]. Recognition of these diverse mechanisms also informs risk stratification, drug monitoring, and individualized therapeutic strategies in affected patients.
The clinical presentation of idiosyncratic drug-induced severe neutropenia is often nonspecific and largely dictated by both the depth and duration of neutropenia, as well as by the presence of secondary infections [1]. Common early symptoms include fever, pharyngitis, malaise, and mucosal ulcerations, which may be subtle and easily overlooked. In cases of profound neutropenia (ANC <0>
Diagnosis requires a high index of suspicion, particularly in elderly individuals, those receiving multiple medications, or patients with comorbidities that predispose to infection. Laboratory evaluation generally reveals isolated neutropenia on complete blood count, with preserved erythroid and platelet lineages. Bone marrow examination is not mandatory in most cases but may be valuable to exclude alternative etiologies such as aplastic anemia, myelodysplastic syndromes, or marrow infiltration [1, 4].
A comprehensive medication history spanning at least the previous three months is essential, as the latency between drug exposure and neutropenia onset can vary, particularly with long acting or depot formulations [15]. Exclusion of infectious, autoimmune, and hematologic causes remains a critical step. Immediate discontinuation of the suspected drug is the cornerstone of management.
Widely applied diagnostic criteria for drug-induced neutropenia include: (1) ANC <1>
The cornerstone of management for non-chemotherapy drug-induced severe neutropenia or agranulocytosis remains early recognition, immediate cessation of the offending agent, and supportive care tailored to both the severity of neutropenia and the patient’s clinical status. Hospital admission is generally recommended for patients with ANC <0>
Daily monitoring of complete blood counts is advised until neutrophil recovery is documented. Concurrent investigations—including blood and urine cultures, chest imaging (radiography or computed tomography), and, when indicated, lumbar puncture or bronchoscopy—should be performed to identify the source of infection and guide targeted therapy [1, 8]. Protective isolation measures may be considered, although their efficacy outside oncology remains debated. In afebrile, clinically stable patients, outpatient management under strict monitoring may be feasible [1]. Most patients demonstrate neutrophil recovery within 1–3 weeks after drug withdrawal; delayed recovery is more frequently observed in elderly patients, those with comorbidities, or individuals with prolonged profound neutropenia.
Ambulatory management may be appropriate for selected low-risk patients without fever or infection, who have stable vital signs, reliable follow-up, and rapid access to hospital care. Outpatient care necessitates frequent blood count monitoring, patient education regarding infection signs, and prompt hospitalization if fever or other complications arise [2]. Adjunctive G-CSF can accelerate neutrophil recovery, supporting ambulatory management in appropriate cases, though prophylactic antibiotics are generally not indicated [8]. Permanent discontinuation of the implicated drug and formal pharmacovigilance reporting remain mandatory.
Several prognostic factors have been consistently associated with adverse outcomes, including age >65 years, profound neutropenia (ANC <0>
Certain patient groups are at increased risk of developing severe non-chemotherapy drug-induced neutropenia or experiencing complications thereof. Elderly individuals represent a particularly vulnerable population due to age-related changes in hematopoiesis, frequent comorbidities, polypharmacy, and altered drug metabolism [1, 8]. The coexistence of renal or hepatic impairment further amplifies susceptibility, prolongs neutropenia, and increases the likelihood of infectious complications. In this context, proactive monitoring and early intervention are essential, particularly when initiating medications with known hematotoxic potential.
Patients with underlying autoimmune diseases, such as Graves’ disease receiving antithyroid agents, are also at elevated risk, reflecting both the immunogenic potential of the drugs and disease-related immune dysregulation [1, 2]. Psychotropic medications, including clozapine and other atypical antipsychotics, warrant careful hematologic surveillance, especially during the first three months of therapy when the incidence of severe neutropenia peaks. Regular complete blood count monitoring and patient education regarding infection signs are integral components of safe therapy in these populations.
Individuals with a history of drug-induced neutropenia, genetic polymorphisms affecting drug metabolism, or specific HLA haplotypes may exhibit heightened susceptibility [10, 14]. Awareness of pharmacogenomic and immunogenetic risk factors could facilitate personalized prescribing and preventive strategies, although routine genetic screening remains investigational.
Outpatient management of low-risk patients may be feasible with structured follow-up, frequent laboratory monitoring, and rapid access to hospital care if infection develops [2, 8]. High-risk patients, however, require inpatient management, aggressive infection surveillance, and consideration of early G-CSF therapy to accelerate neutrophil recovery. Across all populations, permanent discontinuation of the offending drug and pharmacovigilance reporting are mandatory to prevent recurrence and inform public health safety.
Collectively, these considerations underscore the importance of individualized risk assessment and highlight the need for heightened vigilance in populations prone to severe non-chemotherapy drug-induced neutropenia or agranulocytosis. Tailoring monitoring protocols, optimizing supportive care, and integrating emerging predictive tools—such as pharmacogenomic profiling and digital risk models—may further improve outcomes in these vulnerable groups.
HGFs, particularly G-CSF and granulocyte macrophage colony-stimulating factor (GM-CSF), are pivotal cytokines that regulate the proliferation, differentiation, and functional activation of hematopoietic progenitor cells in the bone marrow [17]. G-CSF agents — including filgrastim, lenograstim, and the pegylated derivative pegfilgrastim — exert lineage-specific effects on neutrophils, accelerating maturation, enhancing mobilization into the peripheral circulation, and promoting functional competence (Table 1). In contrast, GM-CSF (e.g., sargramostim) has broader activity across myeloid lineages, including neutrophils, monocytes, eosinophils, and dendritic cells, and may provide additional immunomodulatory benefits [5, 17].
| Growth Factor | Type | Target Lineage | Half-life | Common Use Cases | Side Effects |
| Filgrastim | rHu G-CSF | Neutrophils | 3–4 hours | Drug-induced neutropenia, oncology | Bone pain, leukocytosis |
| Lenograstim | Glycosylated G-CSF | Neutrophils | ~3–4 hours | Similar to filgrastim | Similar to filgrastim |
| Pegfilgrastim | Pegylated G-CSF | Neutrophils | 15–80 hours | Chemotherapy-induced neutropenia | Bone pain, rare ARDS |
| Sargramostim | GM-CSF | Neutrophils, monocytes | 3–5 hours | Neutropenia with monocytopenia, G-CSF failure | Fever, fluid retention |
Table 1: Key Characteristics of Hematopoietic Growth Factors.
Both G-CSF and GM-CSF act through binding to cognate receptors on hematopoietic progenitors, triggering intracellular signaling cascades such as JAK/STAT and PI3K/AKT pathways, thereby promoting proliferation, differentiation, and survival. Pharmacokinetically, filgrastim is rapidly absorbed after subcutaneous administration, with a half-life of 3–4 hours, whereas pegfilgrastim, due to pegylation, exhibits an extended half-life of 15–80 hours, permitting less frequent dosing. Standard regimens for neutropenic patients typically involve 5–10 µg/kg/day until the absolute neutrophil count (ANC) exceeds 1.5 × 10⁹/L for at least 48 hours [5, 18]. GM-CSF is less commonly employed in Europe but may be considered in patients with concomitant monocytopenia or in those unresponsive to G-CSF.
The emergence of biosimilar G-CSFs has expanded accessibility, providing cost-effective alternatives with comparable efficacy and safety [18]. While these agents are primarily indicated for oncology-related neutropenia, off-label use in idiosyncratic, non-chemotherapy drug-induced neutropenia is increasingly reported, supported by retrospective analyses and expert consensus [5]. Adverse effects are generally mild, most commonly manifesting as bone pain, while rare but serious events include splenic rupture, leukocytosis, or hypersensitivity reactions [18].
Although randomized controlled trials are lacking due to the rarity and heterogeneity of idiosyncratic neutropenia, observational studies and case series consistently indicate that HGFs accelerate hematologic recovery and reduce infection-related morbidity [2, 4, 5]. A large European retrospective study involving 203 patients demonstrated that G-CSF therapy shortened the median duration of neutropenia from 10 to 6 days, decreased infectious complications, and reduced hospital length of stay compared with supportive care alone [19]. Similarly, a Spanish cohort reported that early G-CSF initiation improved outcomes, particularly in older patients and those with significant comorbidities [15] (Table 2).
Evidence emphasizes the importance of prompt intervention, ideally within 48 hours of diagnosis, to optimize recovery. GM-CSF has shown efficacy in patients refractory to G-CSF or those with combined cytopenias, although comparative data between agents remain limited. Importantly, growth factor therapy does not appear to increase relapse rates or mortality, supporting a favorable risk–benefit profile in idiosyncratic agranulocytosis [5, 8].
Several G-CSF formulations are available for clinical use, including filgrastim (non-glycosylated recombinant human G-CSF), lenograstim (glycosylated form), and pegfilgrastim (pegylated long-acting derivative) (17). While mechanistically similar, these agents differ in pharmacokinetics, immunogenicity, and dosing schedules. Filgrastim is commonly administered daily in Europe, whereas pegfilgrastim allows once-per-cycle dosing, though its use in non-chemotherapy settings remains limited [5, 17].
Lenograstim’s glycosylation enhances receptor affinity and reduces clearance, potentially yielding faster neutrophil recovery. Pegfilgrastim’s prolonged half-life is advantageous in oncology but may offer limited additional benefit in self-limiting idiosyncratic neutropenia and is associated with higher cost (17). Sargramostim (GM-CSF) exerts broader myeloid effects, useful for concurrent cytopenias or G-CSF refractory cases, but is linked to higher rates of fever, arthralgia, and fluid retention.
Consequently, G-CSF remains the preferred first-line agent for most patients, with selection guided by availability, comorbidities, and prior response [5, 17].
HGFs are generally well tolerated, yet their use in non-chemotherapy drug-induced neutropenia warrants careful consideration. Bone pain is the most frequently reported adverse effect, occurring in up to one-third of treated individuals; although typically mild to moderate, it may necessitate symptomatic management with acetaminophen or non-steroidal anti-inflammatory agents (5). Other common adverse reactions include headache, local injection-site erythema, and fatigue. Rare but serious complications — including splenic rupture, leukocytosis, capillary leak syndrome, and acute respiratory distress syndrome (ARDS) — have been described, underscoring the need for vigilant clinical monitoring in hospitalized patients [1,5].
A persistent limitation in this field is the absence of prospective, randomized controlled trials, a reflection of the rarity, heterogeneity, and often-unpredictable onset of idiosyncratic drug-induced neutropenia [1, 8]. Consequently, current therapeutic recommendations rely heavily on retrospective cohorts, pharmacovigilance registries, and expert consensus. The wide diversity of implicated medications, along with variability in the depth and duration of neutropenia, complicates the development of standardized, evidence-based treatment algorithms [2]. Although early G-CSF administration is widely advocated in cases of profound neutropenia or established infection, its role in moderate or asymptomatic presentations remains debated, particularly given that spontaneous recovery is common once the offending agent is withdrawn [2,5].
Concerns have also emerged regarding potential overuse of G-CSF in scenarios where conservative management might be equally effective, raising questions about cost-effectiveness, resource allocation, and the risk of overtreatment [1]. Ethical challenges arise in situations of uncertain drug causality — for example, in multimorbid or polymedicated patients — in whom growth factor initiation may be considered despite diagnostic ambiguity. The increasing availability of biosimilar G-CSF products introduces more affordable options, but their long-term safety and performance in this off-label context require continued pharmacovigilance and systematic evaluation.
Given these uncertainties, large-scale international registries and robust post-marketing surveillance systems remain essential to refine patient selection, clarify indications, and advance the safe and judicious use of HGFs in idiosyncratic drug-induced agranulocytosis [15].
Several emerging scientific and clinical avenues hold considerable promise for improving the prevention and management of non-chemotherapy drug-induced neutropenia. A major frontier lies in the integration of pharmacogenomic strategies to identify individuals at heightened susceptibility to idiosyncratic reactions [19]. The association between specific HLA alleles and clozapine-induced agranulocytosis provides a compelling proof of concept, demonstrating the potential for genotype-informed prescribing and individualized risk mitigation [20]. Extending genomic screening to other high-risk medications may enable earlier identification of vulnerable patients and help avert severe complications.
Parallel advances in the development of next-generation HGFs are also noteworthy. Novel formulations — including long acting, engineered, or multispecific colony-stimulating factors — may offer enhanced pharmacodynamic profiles, reduced dosing frequency, and improved tolerability. Agents designed to target multiple myeloid lineages or to modulate inflammatory networks could benefit patients with refractory or complex cytopenias, for whom current therapies remain suboptimal.
Beyond pharmacologic innovation, digital health technologies provide an additional opportunity to transform clinical practice. Artificial intelligence and machine learning applied to large-scale electronic health record datasets may enable earlier detection of drug-induced neutropenia by identifying subtle trends in laboratory parameters, symptom trajectories, or prescribing patterns before overt clinical deterioration occurs [20]. Such tools could support proactive monitoring and decision-making, particularly in high-risk or polymedicated populations.
Finally, strengthening collaborative research infrastructures is essential. International registries, harmonized pharmacovigilance systems, and multicenter observational studies are needed to generate robust epidemiological data, refine diagnostic and causality assessment criteria, and inform standardized treatment algorithms. Close collaboration among hematologists, internists, clinical pharmacists, and regulatory agencies will be critical to improving the timely identification, reporting, and management of this uncommon yet serious adverse drug reaction. Ultimately, integrating precision medicine paradigms into routine hematologic practice may reshape both prevention and care for idiosyncratic agranulocytosis.
Idiosyncratic non-chemotherapy drug-induced neutropenia and agranulocytosis, although rare, remain clinically significant and potentially life-threatening adverse drug reactions, particularly in older adults and patients with multimorbidity. Early recognition, immediate discontinuation of the causative agent, and aggressive supportive care are central to optimizing outcomes. HGFs — most notably G-CSF — have demonstrated consistent benefit in accelerating neutrophil recovery, reducing infectious complications, and improving clinical trajectories, with a generally favorable safety profile when applied judiciously.
Persistent challenges include the rarity and heterogeneity of the syndrome, the absence of randomized trials, and substantial variation in clinical presentation and management practices. Future advances will depend on the integration of pharmacogenomic risk stratification, development of novel growth factor therapeutics, incorporation of digital health and AI-driven early detection tools, and expansion of international registries to strengthen the evidence base.
Taken together, these strategies offer a pathway toward a more precise, mechanistically informed, and patient-centered approach to the prevention and treatment of idiosyncratic drug-induced neutropenia — with the potential to meaningfully improve safety, outcomes, and quality of care.
The authors declare no conflicts of interest directly related to the content of this manuscript. Professor Andrès has received research funding and honoraria from pharmaceutical companies involved in the development and commercialization of hematopoietic growth factors. All other authors report no competing interests.
The authors acknowledge the indispensable support of digital and bibliographic tools in the preparation and finalization of this manuscript. ChatGPT (GPT-5 Mini, OpenAI) was utilized to assist with drafting, linguistic refinement, and structural organization of complex sections. Gemini contributed to research and data aggregation. Literature searches were facilitated by PubMed, and reference management was performed using Zotero. The Microsoft Office Suite supported document formatting and figure assembly.
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Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.
Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."
I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.
To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.
"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".
I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.
Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.
We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.
My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.
To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina
Dear Jessica, and the super professional team of the ‘Clinical Cardiology and Cardiovascular Interventions’ I am sincerely grateful to the coordinated work of the journal team for the no problem with the submission of my manuscript: “Cardiometabolic Disorders in A Pregnant Woman with Severe Preeclampsia on the Background of Morbid Obesity (Case Report).” The review process by 5 experts was fast, and the comments were professional, which made it more specific and academic, and the process of publication and presentation of the article was excellent. I recommend that my colleagues publish articles in this journal, and I am interested in further scientific cooperation. Sincerely and best wishes, Dr. Oleg Golyanovskiy.
Dear Ashley Rosa, Editorial Coordinator of the journal - Psychology and Mental Health Care. " The process of obtaining publication of my article in the Psychology and Mental Health Journal was positive in all areas. The peer review process resulted in a number of valuable comments, the editorial process was collaborative and timely, and the quality of this journal has been quickly noticed, resulting in alternative journals contacting me to publish with them." Warm regards, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. I appreciate the journal (JCCI) editorial office support, the entire team leads were always ready to help, not only on technical front but also on thorough process. Also, I should thank dear reviewers’ attention to detail and creative approach to teach me and bring new insights by their comments. Surely, more discussions and introduction of other hemodynamic devices would provide better prevention and management of shock states. Your efforts and dedication in presenting educational materials in this journal are commendable. Best wishes from, Farahnaz Fallahian.
Dear Maria Emerson, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. I am delighted to have published our manuscript, "Acute Colonic Pseudo-Obstruction (ACPO): A rare but serious complication following caesarean section." I want to thank the editorial team, especially Maria Emerson, for their prompt review of the manuscript, quick responses to queries, and overall support. Yours sincerely Dr. Victor Olagundoye.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. Many thanks for publishing this manuscript after I lost confidence the editors were most helpful, more than other journals Best wishes from, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Agrippa Hilda, Editorial Coordinator, Journal of Neuroscience and Neurological Surgery. The entire process including article submission, review, revision, and publication was extremely easy. The journal editor was prompt and helpful, and the reviewers contributed to the quality of the paper. Thank you so much! Eric Nussbaum, MD
Dr Hala Al Shaikh This is to acknowledge that the peer review process for the article ’ A Novel Gnrh1 Gene Mutation in Four Omani Male Siblings, Presentation and Management ’ sent to the International Journal of Clinical Case Reports and Reviews was quick and smooth. The editorial office was prompt with easy communication.
Dear Erin Aust, Editorial Coordinator, Journal of General Medicine and Clinical Practice. We are pleased to share our experience with the “Journal of General Medicine and Clinical Practice”, following the successful publication of our article. The peer review process was thorough and constructive, helping to improve the clarity and quality of the manuscript. We are especially thankful to Ms. Erin Aust, the Editorial Coordinator, for her prompt communication and continuous support throughout the process. Her professionalism ensured a smooth and efficient publication experience. The journal upholds high editorial standards, and we highly recommend it to fellow researchers seeking a credible platform for their work. Best wishes By, Dr. Rakhi Mishra.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. The peer review process of the journal of Clinical Cardiology and Cardiovascular Interventions was excellent and fast, as was the support of the editorial office and the quality of the journal. Kind regards Walter F. Riesen Prof. Dr. Dr. h.c. Walter F. Riesen.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. Thank you for publishing our article, Exploring Clozapine's Efficacy in Managing Aggression: A Multiple Single-Case Study in Forensic Psychiatry in the international journal of clinical case reports and reviews. We found the peer review process very professional and efficient. The comments were constructive, and the whole process was efficient. On behalf of the co-authors, I would like to thank you for publishing this article. With regards, Dr. Jelle R. Lettinga.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, I would like to express my deep admiration for the exceptional professionalism demonstrated by your journal. I am thoroughly impressed by the speed of the editorial process, the substantive and insightful reviews, and the meticulous preparation of the manuscript for publication. Additionally, I greatly appreciate the courteous and immediate responses from your editorial office to all my inquiries. Best Regards, Dariusz Ziora
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation, Auctores Publishing LLC, We would like to thank the editorial team for the smooth and high-quality communication leading up to the publication of our article in the Journal of Neurodegeneration and Neurorehabilitation. The reviewers have extensive knowledge in the field, and their relevant questions helped to add value to our publication. Kind regards, Dr. Ravi Shrivastava.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, Auctores Publishing LLC, USA Office: +1-(302)-520-2644. I would like to express my sincere appreciation for the efficient and professional handling of my case report by the ‘Journal of Clinical Case Reports and Studies’. The peer review process was not only fast but also highly constructive—the reviewers’ comments were clear, relevant, and greatly helped me improve the quality and clarity of my manuscript. I also received excellent support from the editorial office throughout the process. Communication was smooth and timely, and I felt well guided at every stage, from submission to publication. The overall quality and rigor of the journal are truly commendable. I am pleased to have published my work with Journal of Clinical Case Reports and Studies, and I look forward to future opportunities for collaboration. Sincerely, Aline Tollet, UCLouvain.
Dear Ms. Mayra Duenas, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. “The International Journal of Clinical Case Reports and Reviews represented the “ideal house” to share with the research community a first experience with the use of the Simeox device for speech rehabilitation. High scientific reputation and attractive website communication were first determinants for the selection of this Journal, and the following submission process exceeded expectations: fast but highly professional peer review, great support by the editorial office, elegant graphic layout. Exactly what a dynamic research team - also composed by allied professionals - needs!" From, Chiara Beccaluva, PT - Italy.
Dear Maria Emerson, Editorial Coordinator, we have deeply appreciated the professionalism demonstrated by the International Journal of Clinical Case Reports and Reviews. The reviewers have extensive knowledge of our field and have been very efficient and fast in supporting the process. I am really looking forward to further collaboration. Thanks. Best regards, Dr. Claudio Ligresti
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation. “The peer review process was efficient and constructive, and the editorial office provided excellent communication and support throughout. The journal ensures scientific rigor and high editorial standards, while also offering a smooth and timely publication process. We sincerely appreciate the work of the editorial team in facilitating the dissemination of innovative approaches such as the Bonori Method.” Best regards, Dr. Matteo Bonori.
I recommend without hesitation submitting relevant papers on medical decision making to the International Journal of Clinical Case Reports and Reviews. I am very grateful to the editorial staff. Maria Emerson was a pleasure to communicate with. The time from submission to publication was an extremely short 3 weeks. The editorial staff submitted the paper to three reviewers. Two of the reviewers commented positively on the value of publishing the paper. The editorial staff quickly recognized the third reviewer’s comments as an unjust attempt to reject the paper. I revised the paper as recommended by the first two reviewers.
Dear Maria Emerson, Editorial Coordinator, Journal of Clinical Research and Reports. Thank you for publishing our case report: "Clinical Case of Effective Fetal Stem Cells Treatment in a Patient with Autism Spectrum Disorder" within the "Journal of Clinical Research and Reports" being submitted by the team of EmCell doctors from Kyiv, Ukraine. We much appreciate a professional and transparent peer-review process from Auctores. All research Doctors are so grateful to your Editorial Office and Auctores Publishing support! I amiably wish our article publication maintained a top quality of your International Scientific Journal. My best wishes for a prosperity of the Journal of Clinical Research and Reports. Hope our scientific relationship and cooperation will remain long lasting. Thank you very much indeed. Kind regards, Dr. Andriy Sinelnyk Cell Therapy Center EmCell
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. It was truly a rewarding experience to work with the journal “Clinical Cardiology and Cardiovascular Interventions”. The peer review process was insightful and encouraging, helping us refine our work to a higher standard. The editorial office offered exceptional support with prompt and thoughtful communication. I highly value the journal’s role in promoting scientific advancement and am honored to be part of it. Best regards, Meng-Jou Lee, MD, Department of Anesthesiology, National Taiwan University Hospital.
Dear Editorial Team, Journal-Clinical Cardiology and Cardiovascular Interventions, “Publishing my article with Clinical Cardiology and Cardiovascular Interventions has been a highly positive experience. The peer-review process was rigorous yet supportive, offering valuable feedback that strengthened my work. The editorial team demonstrated exceptional professionalism, prompt communication, and a genuine commitment to maintaining the highest scientific standards. I am very pleased with the publication quality and proud to be associated with such a reputable journal.” Warm regards, Dr. Mahmoud Kamal Moustafa Ahmed
Dear Maria Emerson, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews’, I appreciate the opportunity to publish my article with your journal. The editorial office provided clear communication during the submission and review process, and I found the overall experience professional and constructive. Best regards, Elena Salvatore.
Dear Mayra Duenas, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews Herewith I confirm an optimal peer review process and a great support of the editorial office of the present journal
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. I am really grateful for the peers review; their feedback gave me the opportunity to reflect on the message and impact of my work and to ameliorate the article. The editors did a great job in addition by encouraging me to continue with the process of publishing.
Dear Cecilia Lilly, Editorial Coordinator, Endocrinology and Disorders, Thank you so much for your quick response regarding reviewing and all process till publishing our manuscript entitled: Prevalence of Pre-Diabetes and its Associated Risk Factors Among Nile College Students, Sudan. Best regards, Dr Mamoun Magzoub.
International Journal of Clinical Case Reports and Reviews is a high quality journal that has a clear and concise submission process. The peer review process was comprehensive and constructive. Support from the editorial office was excellent, since the administrative staff were responsive. The journal provides a fast and timely publication timeline.
Dear Maria Emerson, Editorial Coordinator of International Journal of Clinical Case Reports and Reviews, What distinguishes International Journal of Clinical Case Report and Review is not only the scientific rigor of its publications, but the intellectual climate in which research is evaluated. The submission process is refreshingly free of unnecessary formal barriers and bureaucratic rituals that often complicate academic publishing without adding real value. The peer-review system is demanding yet constructive, guided by genuine scientific dialogue rather than hierarchical or authoritarian attitudes. Reviewers act as collaborators in improving the manuscript, not as gatekeepers imposing arbitrary standards. This journal offers a rare balance: high methodological standards combined with a respectful, transparent, and supportive editorial approach. In an era where publishing can feel more burdensome than research itself, this platform restores the original purpose of peer review — to refine ideas, not to obstruct them Prof. Perlat Kapisyzi, FCCP PULMONOLOGIST AND THORACIC IMAGING.
Dear Grace Pierce, International Journal of Clinical Case Reports and Reviews I appreciate the opportunity to review for Auctore Journal, as the overall editorial process was smooth, transparent and professionally managed. This journal maintains high scientific standards and ensures timely communications with authors, which is truly commendable. I would like to express my special thanks to editor Grace Pierce for his constant guidance, promt responses, and supportive coordination throughout the review process. I am also greatful to Eleanor Bailey from the finance department for her clear communication and efficient handling of all administrative matters. Overall, my experience with Auctore Journal has been highly positive and rewarding. Best regards, Sabita sinha
Dear Mayra Duenas, Editorial Coordinator of the journal IJCCR, I write here a little on my experience as an author submitting to the International Journal of Clinical Case Reports and Reviews (IJCCR). This was my first submission to IJCCR and my manuscript was inherently an outsider’s effort. It attempted to broadly identify and then make some sense of life’s under-appreciated mysteries. I initially had responded to a request for possible submissions. I then contacted IJCCR with a tentative topic for a manuscript. They quickly got back with an approval for the submission, but with a particular requirement that it be medically relevant. I then put together a manuscript and submitted it. After the usual back-and-forth over forms and formality, the manuscript was sent off for reviews. Within 2 weeks I got back 4 reviews which were both helpful and also surprising. Surprising in that the topic was somewhat foreign to medical literature. My subsequent updates in response to the reviewer comments went smoothly and in short order I had a series of proofs to evaluate. All in all, the whole publication process seemed outstanding. It was both helpful in terms of the paper’s content and also in terms of its efficient and friendly communications. Thank you all very much. Sincerely, Ted Christopher, Rochester, NY.
