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Treatment of severe clozapine-induced neutropenia with granulocyte colony-stimulating factor (G-CSF)

Remission despite continuous treatment with clozapine

Published online by Cambridge University Press:  03 January 2018

B. Sperner-Unterweger ,
I. Czeipek ,
S. Gaggl ,
D. Geissler ,
G. Spiel  and
W. W. Fleischhacker
B. Sperner-Unterweger*
Affiliation:
Innsbruck University Clinics, Department of Biological Psychiatry
I. Czeipek
Affiliation:
Department of Pediatric Psychiatry, State Hospital Klagenfurt
S. Gaggl
Affiliation:
Department of Internal Medicine, Innsbruck University Clinics
D. Geissler
Affiliation:
Department of Internal Medicine, State Hospital Klagenfurt, A-9020 Klagenfurt, Austria
G. Spiel
Affiliation:
Department of Pediatric Psychiatry, State Hospital Klagenfurt, A-9020 Klagenfurt, Austria
W. W. Fleischhacker
Affiliation:
Innsbruck University Clinics, Department of Biological Psychiatry
*
Dr B. Sperner-Unterweger, Innsbruck University Clinics, Department of Biological Psychiatry, A-6020 Innsbruck/Austria. Fax: +43/512/504-3628; e-mail: Barbara.Sperner-Unterweger@uibk.at.ac
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Abstract

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.

Method and 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.

Type
Papers
Information
The British Journal of Psychiatry , Volume 172 , Issue 1 , January 1998 , pp. 82 - 84
Copyright
Copyright © 1998 The Royal College of Psychiatrists 

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References

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