title: Hematological adverse events in clozapine-treated children and adolescents.
abstract: OBJECTIVE
  To retrospectively examine rates of hematological adverse events (HAEs) in psychiatrically ill, hospitalized children treated with clozapine.
  
  
  METHODS
  Clozapine treatment was administered in an open-label fashion using a flexible titration schedule, and data from weekly complete blood counts was obtained. The rate of neutropenia and agranulocytosis (HAEs) development was determined for 172 eligible patients (mean age at clozapine initiation, 15.03 +/- 2.13 years) with a median observation period of 8 months.
  
  
  RESULTS
  Neutropenia (absolute neutrophil count <1,500/mm) developed in 23 (13%) patients and agranulocytosis (absolute neutrophil count <500/mm) in one (0.6%) patient. The cumulative probability of developing an initial HAE at 1 year of clozapine treatment was 16.1% (95% confidence interval 9.7%-22.5%). Eleven (48%) of 24 patients who developed an HAE were successfully rechallenged on clozapine. Eight (5%) of 172 patients from this sample eventually discontinued clozapine because of an HAE (one agranulocytosis, seven neutropenia).
  
  
  CONCLUSIONS
  The occurrence of HAEs is a significant risk associated with the administration of clozapine. However, in this sample, few children actually discontinued therapy because of an HAE and the incidence of agranulocytosis does not appear higher than what has been reported in the adult literature.
authors.affiliation: Bronx Children's Psychiatric Center, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Ginny
authors.initials: G
authors.lastname: Gerbino-Rosen
authors.forename: David
authors.initials: D
authors.lastname: Roofeh
authors.forename: D Andrew
authors.initials: DA
authors.lastname: Tompkins
authors.forename: Doug
authors.initials: D
authors.lastname: Feryo
authors.forename: Laurie
authors.initials: L
authors.lastname: Nusser
authors.forename: Harvey
authors.initials: H
authors.lastname: Kranzler
authors.forename: Barbara
authors.initials: B
authors.lastname: Napolitano
authors.forename: Anne
authors.initials: A
authors.lastname: Frederickson
authors.forename: Inika
authors.initials: I
authors.lastname: Henderson
authors.forename: Joe
authors.initials: J
authors.lastname: Rhinewine
authors.forename: Sanjiv
authors.initials: S
authors.lastname: Kumra
mesh_terms: D000293:Adolescent; D000380:Agranulocytosis / Q000139:chemically induced* / Q000453:epidemiology; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D003024:Clozapine / Q000009:adverse effects* / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D009503:Neutropenia / Q000139:chemically induced* / Q000453:epidemiology; D011618:Psychotic Disorders / Q000188:drug therapy*; D012189:Retrospective Studies
chemical_list: D014150:Antipsychotic Agents; D003024:Clozapine