RECOMBINANT HUMAN GRANULOCYTE-COLONY-STIMULATING FACTOR (RHG-CSF FILGRASTIM) TREATMENT OF CLOZAPINE-INDUCED AGRANULOCYTOSIS

After 10 weeks of treatment with clozapine, severe agranulocytosis was diagnosed in a 33-year-old female. The patient was treated with filgrastim (granulocyte colony-stimulating factor [G-CSF]) 5 mu g kg(-1) day(-1). The neutrophil count was 0.234 x 10(9)l(-1) on admission, with a further decrease the next day to < 0.050 x lO(9) l(-1), and this complete agranulocytosis continued for 10 days. As no response was obtained after 1 week the dosage of filgrastim was increased to 10 mu g kg-l day(-1) with immediate improvement. A rapid and pronounced leucocytosis developed with maximal value of neutrophil granulocytes (including immature forms) of 33.108 x 10(9) l(-1) on day 12 after admission. The patient only had minor infectious complications during the neutropenic period. In conclusion, early treatment with filgrastim seems warranted in severe cases of clozapine-induced agranulocytosis. A dosage of 10 mu g kg(-1) day(-1) can be recommended.