G-CSF Treatment of Clozapine-Induced Agranulocytosis: A Case Report / 신경정신의학

ABSTRACT

The authors present a successful treatment case of clozapine-induced agranulocytosis with granulocyte colony-stimulating factor(G-CSF). It is the first case in Korea that occurred despite proper monitoring by the Clozaril patient Monitoring System(CPMS) and lull clinical vigliance. The mechanism of clozapine-induced agranulocytosis is unknown. Various studies are attempting to identity the pathogenic mechanism involved, and whether it is immunologic like human leukocyte antigen(HLA)-associated or toxic like desmethylclozapine-associated. However, it is clear that the final common pathway is suppression of myeloid proliferation in the bone marrow. The theory that clozapine-induced agranulocytosis Is caused by suppression of colony forming units of granulocytes and macrophages(CFU-GM) forms the rationale far the use of G-CSF or GM-CSF. The management of clozapine-induced agranulocytosis should include accurate diagnosis of agranulocytosis through bone marrow examinations, prompt discontinuation of clozapine, consultation with a hematologist, infectious disease specialist. Reverse isolation and administration of prophylactic antibiotics are need for prevention of secondary infection. A potential decrease of recovery time achieved by G-CSF obviously lowers the risk of secondary infectious disease.