Clozapine reinitiation following a "red result" secondary to chemotherapy

Tariq Munshi, Mir Mazhar, Tariq HassanDepartment of Psychiatry, Kingston General Hospital, Kingston, ON, CanadaAbstract: We describe a case of a patient whose clozapine was discontinued after a "red result" following R-CHOP (rituximab with cyclophosphamide, hydroxydaunorubicin, Oncovin, an...

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Autores principales:	Munshi T, Mazhar M, Hassan T
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2013
Materias:	Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/7995d793fb394664a055daff8609ea5f
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spelling	oai:doaj.org-article:7995d793fb394664a055daff8609ea5f2021-12-02T01:36:26ZClozapine reinitiation following a "red result" secondary to chemotherapy1176-63281178-2021https://doaj.org/article/7995d793fb394664a055daff8609ea5f2013-08-01T00:00:00Zhttp://www.dovepress.com/clozapine-reinitiation-following-a-quotred-resultquot-secondary-to-che-a14165https://doaj.org/toc/1176-6328https://doaj.org/toc/1178-2021Tariq Munshi, Mir Mazhar, Tariq HassanDepartment of Psychiatry, Kingston General Hospital, Kingston, ON, CanadaAbstract: We describe a case of a patient whose clozapine was discontinued after a "red result" following R-CHOP (rituximab with cyclophosphamide, hydroxydaunorubicin, Oncovin, and prednisolone) chemotherapy for large B-cell lymphoma. In some cases, manufacturers grant permission, on compassionate grounds, for clozapine to be continued or reinitiated following assessment by their consultant hematologist. Other than a recent case report, there is not much literature surrounding this medical issue. However, since the two leading causes of mortality in schizophrenia are cancer and cardiac disease, this is not an uncommon occurrence. Clinicians are reluctant to prescribe clozapine in view of its side-effect profile, despite its proven efficacy for managing treatment-resistant schizophrenia. The alternative is to prescribe two antipsychotics to manage symptoms. This approach may be associated with increased side effects, and evidence for actual benefits is scant. The consequences were disastrous in this case, as the individual not only relapsed following clozapine discontinuation, but the therapy for this treatable form of lymphoma had to be delayed. He was eventually admitted to an inpatient unit after having been stable for 15 years. We managed to stabilize him with olanzapine and aripiprazole which enabled the heme-oncology group to resume R-CHOP therapy with filgrastim (granulocyte colony-stimulating factor). Even so, he continued to exhibit severe psychotic symptoms, with religious delusions and auditory hallucinations. We therefore applied for permission to rechallenge him on clozapine. Permission was granted when protocol conditions were met, and reinitiation went without any adverse events. The patient's symptoms showed improvement within a few weeks, and the other antipsychotics were discontinued once clozapine was titrated up to 300 mg. The decision to reinitiate clozapine following a red result is not to be taken lightly, but needs to be considered in terms of the risks versus benefits. More literature surrounding this issue would be of great benefit to clinicians, patients, and their families.Keywords: clozapine agranulocytosis, clozapine discontinuation, red result, clozapine rechallenge, R-CHOP chemotherapyMunshi TMazhar MHassan TDove Medical PressarticleNeurosciences. Biological psychiatry. NeuropsychiatryRC321-571Neurology. Diseases of the nervous systemRC346-429ENNeuropsychiatric Disease and Treatment, Vol 2013, Iss default, Pp 1267-1271 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
spellingShingle	Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429 Munshi T Mazhar M Hassan T Clozapine reinitiation following a "red result" secondary to chemotherapy
description	Tariq Munshi, Mir Mazhar, Tariq HassanDepartment of Psychiatry, Kingston General Hospital, Kingston, ON, CanadaAbstract: We describe a case of a patient whose clozapine was discontinued after a "red result" following R-CHOP (rituximab with cyclophosphamide, hydroxydaunorubicin, Oncovin, and prednisolone) chemotherapy for large B-cell lymphoma. In some cases, manufacturers grant permission, on compassionate grounds, for clozapine to be continued or reinitiated following assessment by their consultant hematologist. Other than a recent case report, there is not much literature surrounding this medical issue. However, since the two leading causes of mortality in schizophrenia are cancer and cardiac disease, this is not an uncommon occurrence. Clinicians are reluctant to prescribe clozapine in view of its side-effect profile, despite its proven efficacy for managing treatment-resistant schizophrenia. The alternative is to prescribe two antipsychotics to manage symptoms. This approach may be associated with increased side effects, and evidence for actual benefits is scant. The consequences were disastrous in this case, as the individual not only relapsed following clozapine discontinuation, but the therapy for this treatable form of lymphoma had to be delayed. He was eventually admitted to an inpatient unit after having been stable for 15 years. We managed to stabilize him with olanzapine and aripiprazole which enabled the heme-oncology group to resume R-CHOP therapy with filgrastim (granulocyte colony-stimulating factor). Even so, he continued to exhibit severe psychotic symptoms, with religious delusions and auditory hallucinations. We therefore applied for permission to rechallenge him on clozapine. Permission was granted when protocol conditions were met, and reinitiation went without any adverse events. The patient's symptoms showed improvement within a few weeks, and the other antipsychotics were discontinued once clozapine was titrated up to 300 mg. The decision to reinitiate clozapine following a red result is not to be taken lightly, but needs to be considered in terms of the risks versus benefits. More literature surrounding this issue would be of great benefit to clinicians, patients, and their families.Keywords: clozapine agranulocytosis, clozapine discontinuation, red result, clozapine rechallenge, R-CHOP chemotherapy
format	article
author	Munshi T Mazhar M Hassan T
author_facet	Munshi T Mazhar M Hassan T
author_sort	Munshi T
title	Clozapine reinitiation following a "red result" secondary to chemotherapy
title_short	Clozapine reinitiation following a "red result" secondary to chemotherapy
title_full	Clozapine reinitiation following a "red result" secondary to chemotherapy
title_fullStr	Clozapine reinitiation following a "red result" secondary to chemotherapy
title_full_unstemmed	Clozapine reinitiation following a "red result" secondary to chemotherapy
title_sort	clozapine reinitiation following a "red result" secondary to chemotherapy
publisher	Dove Medical Press
publishDate	2013
url	https://doaj.org/article/7995d793fb394664a055daff8609ea5f
work_keys_str_mv	AT munshit clozapinereinitiationfollowingaredresultsecondarytochemotherapy AT mazharm clozapinereinitiationfollowingaredresultsecondarytochemotherapy AT hassant clozapinereinitiationfollowingaredresultsecondarytochemotherapy
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Clozapine reinitiation following a "red result" secondary to chemotherapy

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