title: Successful clozapine continuation during chemotherapy for the treatment of malignancy: a case report.
abstract: METHODS
  The need for chemotherapy treatment in a cancer patient who uses clozapine raises a clinical dilemma because both therapies can cause agranulocytosis. A 45-year-old male diagnosed with schizophrenia used clozapine together with zuclopenthixol for more than 15 years. Non-Hodgkin's lymphoma was treated with chemotherapy twice, and clozapine was continued during both courses of chemotherapy. Agranulocytosis did not occur during the first treatment. During the second treatment, agranulocytosis occurred, but was attributed to chemotherapy, and blood counts recovered spontaneously. Successful concomitant use of clozapine and cancer chemotherapy is based on a limited number of case reports. However, two case reports describe persistent neutropenia or agranulocytosis, possibly related to this combination.
  
  
  CONCLUSIONS
  Clozapine should only be continued during cancer chemotherapy if favoured by the risk-to-benefit ratio.
authors.affiliation: Department of Pharmaceutical Sciences, University of Utrecht, P.O. Box 80082, 3508 TB, Utrecht, The Netherlands.
authors.forename: Marloes R
authors.initials: MR
authors.lastname: Overbeeke
authors.affiliation: Department of Hospital Pharmacy, Albert Schweitzer Hospital, P.O. Box 444, 3300 AK, Dordrecht, The Netherlands. m.oosterhuis@asz.nl.
authors.forename: Marieke M
authors.identifier: http://orcid.org/0000-0002-3070-3626
authors.initials: MM
authors.lastname: Beex-Oosterhuis
authors.affiliation: Yulius Mental Health Institution, P.O. Box 753, 3300 AT, Dordrecht, The Netherlands.
authors.forename: Ellen
authors.initials: E
authors.lastname: Graveland
authors.affiliation: Yulius Mental Health Institution, P.O. Box 753, 3300 AT, Dordrecht, The Netherlands.
authors.forename: Jannie N den
authors.initials: JN
authors.lastname: Hoed-van Wijk
authors.affiliation: Yulius Mental Health Institution, P.O. Box 753, 3300 AT, Dordrecht, The Netherlands.
authors.forename: Arthur R
authors.initials: AR
authors.lastname: Van Gool
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D014150:Antipsychotic Agents / Q000008:administration & dosage*; D003024:Clozapine / Q000008:administration & dosage*; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D012559:Schizophrenia / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D014150:Antipsychotic Agents; D003024:Clozapine
keywords: Agranulocytosis; Chemotherapy; Clozapine; Constipation; Malignancy; Non-Hodgkin lymphoma