Nazife Gamze Usta1, Cana Aksoy Poyraz2, Melih Aktan3, Alaattin Duran1. 1. Department of Psychiatry, Cerrahpaşa Medical School, University of Istanbul, Turkey. 2. Department of Psychiatry, Cerrahpaşa Medical School, Istanbul, Turkey, Halaskargazi cad. No:81 Çiçek apt. daire:8,Osmanbey Istanbul/Turkey. 3. Department of Internal Medicine, Division of Hematology, Istanbul Medical School, University of Istanbul, Turkey.
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. METHOD: 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. CONCLUSION: Continuing with clozapine in the course of chemotherapy may be relatively safer for patients who responded well to clozapine concomitant with G-CSF treatment.
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. METHOD: 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. CONCLUSION: 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: Domenico De Berardis; Nicola Serroni; Daniela Campanella; Luigi Olivieri; Stefano Marini; Francesco Saverio Moschetta; Giovanni Martinotti; Massimo Di Giannantonio Journal: Gen Hosp Psychiatry Date: 2012-07-21 Impact factor: 3.238
Authors: Marloes R Overbeeke; Marieke M Beex-Oosterhuis; Ellen Graveland; Jannie N den Hoed-van Wijk; Arthur R Van Gool Journal: Int J Clin Pharm Date: 2016-03-07
Authors: Seong Hoon Jeong; Nam Young Lee; Se Hyun Kim; In Won Chung; Tak Youn; Ung Gu Kang; Yong Min Ahn; Han Young You; Yong Sik Kim Journal: Psychiatry Investig Date: 2018-06-21 Impact factor: 2.505