THE TREATMENT OF CLOZAPINE-ASSOCIATED AGRANULOCYTOSIS WITH GRANULOCYTE-COLONY-STIMULATING FACTOR (G-CSF)

During a 5-year period, 6 patients with clozapine-associated agranuloc ytosis who received granulocyte colony-stimulating factor (G-CSF) were compared with 5 subjects who did not receive this treatment, Seven pa tients were asymptomatic, and the weekly leukocyte count alone indicat ed agranulocytosis. The average duration of agranulocytosis was not si gnificantly different between the treated and untreated groups (6.5 vs , 6.6 days), though the treated group had a significantly shorter aver age duration of hospitalization (8.2 vs. 13.5 days), G-CSF administrat ion was well tolerated, and no adverse effects were noted, Incidentall y noted was the recent addition of ranitidine (with the potential for bone marrow toxicity) to clozapine for 2 patients, Currently, weekly w hite cell and differential counts remain the main tools for detecting incipient or occurring agranulocytosis. Until efficacy studies prove o therwise, G-CSF administered soon after the diagnosis of clozapine-ass ociated agranulocytosis may shorten the duration of hospitalization an d thus prove cost-effective.