clozapine and Lymphoma--B-Cell

A 48-year-old man with a history of schizophrenia was diagnosed with B-cell lymphoma of the small bowel. Neutropaenia occurred secondary to chemotherapy, which led to clozapine being discontinued, which resulted in the deterioration of his mental state, in turn, affecting the treatment of lymphoma. Clozapine was later reintroduced alongside granulocyte colony-stimulating factor, leading to improved mental state without any further incidences of neutropaenia.

Topics: Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Antipsychotic Agents; Clozapine; Drug Administration Schedule; Drug Therapy, Combination; Granulocyte Colony-Stimulating Factor; Humans; Lymphoma, B-Cell; Male; Middle Aged; Neutropenia; Schizophrenia; Treatment Outcome

Clozapine is reserved for overcoming treatment resistance in schizophrenia. Malignancy is common in schizophrenia; however, there is limited evidence available on continuing clozapine with chemotherapy, with both having hematological adverse effects.. To report a case on the use of granulocyte colony-stimulating factor (G-CSF) in conjunction with clozapine and chemotherapy.. We searched PubMed for any available information on the use of granulocyte G-CSF with clozapine and chemotherapy. We report the case of a patient with schizophrenia who developed B-cell lymphoma and was treated with chemotherapy consisting of CHOP regimen, rituximab, and methotrexate. He was continued on clozapine and G-CSF.. We did not find any reports on G-CSF use in conjunction with clozapine and chemotherapy. We found case reports and a case series on the use of G-CSF in clozapine rechallenge with clozapine-induced agranulocytosis with mixed results. In our patient on clozapine, the white blood cell counts reduced by chemotherapy, were successfully replenished with the use of filgrastim, a G-CSF.. With risks of psychosis relapse and exacerbation with discontinuing clozapine, the addition of G-CSF could be a useful aid in replenishing white cell counts lost to chemotherapy whilst continuing clozapine. However, further study is needed on this combination.

Topics: Agranulocytosis; Antibodies, Monoclonal, Murine-Derived; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Antipsychotic Agents; Clozapine; Cyclophosphamide; Doxorubicin; Filgrastim; Granulocyte Colony-Stimulating Factor; Humans; Lymphoma, B-Cell; Male; Methotrexate; Middle Aged; Prednisone; Recombinant Proteins; Rituximab; Schizophrenia; Treatment Outcome; Vincristine

Topics: Agranulocytosis; Antipsychotic Agents; Clozapine; Female; Humans; Lymphoma, B-Cell; Schizophrenia