G-CSF and the management of clozapine-induced agranulocytosis.
The agranulocytosis associated with clozapine is, indeed, a serious medical disorder. Patients experience prolonged and profound severe granulocytopenia--often with absolute neutrophil counts of less than 100/cu mm. Patients suffer neutropenic sepsis and often are as sick as patients undergoing induction chemotherapy for lymphoma or leukemia. Thus, it is important to evaluate the state-of-the-art management of such patients and to define the role of growth factors such as granulocyte colony-stimulating factor (G-CSF) and granulocyte-macrophage colony-stimulating factor (GM-CSF). Early use of G-CSF or GM-CSF can shorten the duration of granulocytopenia from a mean of 16 to 8 days and reduce the morbidity of the disorder. Such intervention can potentially decrease the total cost of agranulocytosis. Further issues under consideration are the early use of hematopoietic growth factors prior to the onset of agranulocytosis and the use of these factors for the outpatient management of this disorder.
Gerson
S L
SL
Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio 44106-4937.
D000380:Agranulocytosis / Q000139:chemically induced / Q000191:economics / Q000517:prevention & control*; D000553:Ambulatory Care; D003024:Clozapine / Q000009:adverse effects* / Q000627:therapeutic use; D003365:Costs and Cost Analysis; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use*; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000627:therapeutic use; D016298:Hematopoietic Cell Growth Factors / Q000627:therapeutic use; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007958:Leukocyte Count; D009504:Neutrophils; D016896:Treatment Outcome
D016298:Hematopoietic Cell Growth Factors; D016179:Granulocyte Colony-Stimulating Factor; D016178:Granulocyte-Macrophage Colony-Stimulating Factor; D003024:Clozapine