title: Clozapine treatment of refractory schizophrenia during essential chemotherapy: a case study and mini review of a clinical dilemma.
abstract: BACKGROUND
  Clozapine remains the antipsychotic of choice for refractory schizophrenia. Given the particular side effects of clozapine including neutropenia and myelosuppression, safety and efficacy of add-on chemotherapy for patients who are already under clozapine treatment remain unknown.
  
  
  OBJECTIVE
  We present evidence from a patient with a diagnosis of refractory schizophrenia on clozapine medication, who required essential chemotherapy for chronic lymphocytic leukemia (CLL). We have also reviewed literature regarding this challenging clinical dilemma.
  
  
  METHODS
  We report details about a patient with treatment-resistant schizophrenia who was given chemotherapy (fludarabine, cyclophosphamide and rituximab) for CLL in the course of concomitant treatment with clozapine and granulocyte-colony stimulating factor (G-CSFs). In addition, we have reviewed literature using the PUBMED data base.
  
  
  RESULTS
  Current evidence remains insufficient to provide authoritative guide to clinicians regarding the efficacy and safety of the combined use of clozapine and chemotherapy. However, general conclusion from our case and of the published evidence is that a combination of clozapine use and chemotherapeutic agents do not cause additional hematological worsening with no decreasing efficacy concerns raised.
  
  
  CONCLUSIONS
  Continuing with clozapine in the course of chemotherapy may be relatively safer for patients who responded well to clozapine concomitant with G-CSF treatment.
authors.affiliation: Department of Psychiatry, Cerrahpaşa Medical School, University of Istanbul, Turkey.
authors.forename: Nazife Gamze
authors.initials: NG
authors.lastname: Usta
authors.affiliation: Department of Psychiatry, Cerrahpaşa Medical School, Istanbul, Turkey, Halaskargazi cad. No:81 Çiçek apt. daire:8,Osmanbey Istanbul/Turkey.
authors.forename: Cana Aksoy
authors.initials: CA
authors.lastname: Poyraz
authors.affiliation: Department of Internal Medicine, Division of Hematology, Istanbul Medical School, University of Istanbul, Turkey.
authors.forename: Melih
authors.initials: M
authors.lastname: Aktan
authors.affiliation: Department of Psychiatry, Cerrahpaşa Medical School, University of Istanbul, Turkey.
authors.forename: Alaattin
authors.initials: A
authors.lastname: Duran
keywords: agranulocytosis; chemotherapy; clozapine; schizophrenia