Combined Antitumor Chemotherapy in a Refractory Schizophrenic Receiving Clozapine / 신경정신의학

ABSTRACT

It has been known that clozapine treatment combining with cytotoxic antitumor therapy for schizophrenia is not recommended because both durgs have agranulocytosis as their side effect. Since the introduction of granulocyte colony-stimulating factor(G-CSF), it has been used to treat agranulocytosis or granulocytopenia associated with antitumor chemotherapy or clozapine. We report a case with schizophrenia on clozapine treatment who developed agranulocytosis following combined cytotoxic chemotherapy for a sex-cord stromal tumor which was successfully treated with G-CSF. The hematological status before combining with antitumor chemotherapy had been within normal range, and agranulocytosis following the antitumor chemotherapy returned to normal after treatment with G-CSF. This suggests that clozapine could be administered in combination with cytotoxic antitumor agents if the following indications are met normal hematological status before starting antitumor chemotherapy, carefully monitoring hematological status by oncologist and psychiatrist, and prepared G-CSF administration when agranulocytosis is anticipated.