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The development of leukaemia in a patient receiving clozapine

Bro Morgannwg NHS Trust, Coity Clinic, Princess of Wales Hospital, Coity Road, Bridgend CF31 1RQ

Sir: Patients receiving clozapine must be registered with the Clozaril Patient Monitoring Service (CPMS) for regular haematological monitoring to reduce the risk of agranulocytosis. We report the case of a 55-year-old patient with a 26-year history of paranoid schizophrenia, whose illness had been well-controlled for 4 years with 400 mg clozapine. Unfortunately, the development of chronic lymphocytic leukaemia necessitated withdrawal of clozapine, resulting in a florid relapse of schizophrenia.

A review of the previous test results revealed they were consistently reported as ‘green’ by the CPMS, despite a gradually rising total white cell count from 8 to 20 over the previous 3 years. The total white cell count ranged from 11 to 15 until a recent increase to 20. As this patient's schizophrenia was well controlled on clozapine, this was continued until diagnosis of chronic lymphocytic leukaemia was made at routine review. A subsequent haematological opinion has not suggested any treatment.

There are isolated reports of leukaemia associated with clozapine, but the observed rate is probably the same as the background incidence, with little evidence of a causal relationship. Other haematological abnormalities have been reported in patients taking clozapine, including leucocytosis, lymphopenia, eosinophilia, thrombocytopenia and anaemia (Mendelowitz et al, 1995; Barbui et al, 1997). Clinicians should be aware that the CPMS only monitors for a low total white cell and neutrophil count. They should therefore remain alert to the possibility of less common haematological disorders and should not rely entirely on a ‘green’ result from the CPMS.

References

BARBUI, C., CAMPOMORI, A. & BONATI, M. (1997) Clozapine and blood dyscrasias different from agranulocytosis. Canadian Journal of Psychiatry — revue canadienne de psychiatrie, 42, 981-982.

MENDELOWITZ, A. J., STANTON, L., GERSON, L., et al (1995) Clozapine induced agranulocytosis. CNS Drugs, 4, 412-421.

This Article Full Text (PDF) Submit an eLetter Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Ali, I. M. Articles by Adeyemo, T. Search for Related Content PubMed Articles by Ali, I. M. Articles by Adeyemo, T.