Treatment of severe clozapine-induced neutropenia with granulocyte colony-stimulating factor (G-CSF). Remission despite continuous treatment with clozapine.
BACKGROUND
A 17-year-old boy suffering from a severe schizophrenic disorder of the paranoid type and mental retardation did not respond to treatment with typical antipsychotics, whereas under clozapine treatment he showed a favourable response. Discontinuation of clozapine led to an acute psychotic relapse. During clozapine treatment the patient developed severe neutropenia.


RESULTS
Due to the history of unsatisfactory response to traditional antipsychotics, clozapine treatment was continued despite white blood cell (WBC) decline. Concomitant treatment with G-CSF was followed by a rapid normalisation of WBC.


CONCLUSIONS
This case report is not intended to challenge the clinical practice of discontinuing clozapine upon the development of neutropenia/agranulocytosis, but rather to stimulate further research in the pathophysiology and clinical consequences of a clozapine rechallenge after a WBC decline, especially in patients with a rather complex symptomatology where no sufficient therapeutic results can be achieved with any other pharmacological intervention than clozapine.
Sperner-Unterweger
B
B
Innsbruck University Clinics, Department of Biological Psychiatry, Austria. Barbara.Sperner-Unterweger@uibk.at.ac
Czeipek
I
I
Gaggl
S
S
Geissler
D
D
Spiel
G
G
Fleischhacker
W W
WW
D000293:Adolescent; D014150:Antipsychotic Agents / Q000009:adverse effects*; D003024:Clozapine / Q000009:adverse effects*; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use*; D006801:Humans; D008607:Intellectual Disability; D008297:Male; D009503:Neutropenia / Q000139:chemically induced / Q000628:therapy*; D012563:Schizophrenia, Paranoid / Q000188:drug therapy
D014150:Antipsychotic Agents; D016179:Granulocyte Colony-Stimulating Factor; D003024:Clozapine