Granulocyte colony stimulating factor (G-CSF) can allow treatment with clozapine in a patient with severe benign ethnic neutropaenia (BEN): a case report.
Clozapine is the treatment of choice for treatment-resistant schizophrenia, but it is associated with a risk of neutropaenia and agranulocytosis. Clozapine use is regulated by mandatory blood monitoring in the UK, requiring cessation of treatment should the absolute neutrophil count (ANC) drop below specified values. Benign reductions in the ANC in non-white populations are common, and this can preclude a patient from receiving treatment with clozapine. A diagnosis of benign ethnic neutropaenia can reduce these treatment restrictions (UK specific), but the degree of neutropaenia can be significant enough to still prevent treatment. In this report, we show that response to granulocyte colony stimulating factor (G-CSF) may be quite variable and difficult to predict, but with careful monitoring it can be used to increase the ANC count and allow continued treatment with clozapine.
South London and Maudsley NHS Foundation Trust, London, UK. benjamin.spencer@kcl.ac.uk
Benjamin W J
BW
Spencer
Hugh R J
HR
Williams
Siobhan H
SH
Gee
Eromona
E
Whiskey
Joseph P
JP
Rodrigues
Aleksandar
A
Mijovic
James H
JH
MacCabe
D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D044383:Black People; D003024:Clozapine / Q000009:adverse effects* / Q000627:therapeutic use; D004347:Drug Interactions; D016903:Drug Monitoring; D004351:Drug Resistance; D000069585:Filgrastim; D016179:Granulocyte Colony-Stimulating Factor / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007155:Immunologic Factors / Q000009:adverse effects / Q000627:therapeutic use*; D007958:Leukocyte Count; D008297:Male; D009503:Neutropenia / Q000139:chemically induced / Q000188:drug therapy* / Q000208:ethnology / Q000503:physiopathology; D009504:Neutrophils / Q000187:drug effects / Q000276:immunology; D011092:Polyethylene Glycols; D011994:Recombinant Proteins / Q000009:adverse effects / Q000627:therapeutic use; D012559:Schizophrenia / Q000097:blood / Q000188:drug therapy / Q000276:immunology; D012720:Severity of Illness Index; D016896:Treatment Outcome; D006113:United Kingdom; D055815:Young Adult
D014150:Antipsychotic Agents; D007155:Immunologic Factors; D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor; C455861:pegfilgrastim; D011092:Polyethylene Glycols; D003024:Clozapine; D000069585:Filgrastim