DOI: https://doi.org/10.36347/sasjm.2026.v12i05.016

Pages: 449-453

Caring for a patient who has both multiple myeloma (MM) and treatment-resistant schizophrenia forces clinicians into a space where no organ system is safe from collateral damage. Clozapine, the irreplaceable antipsychotic for treatment-resistant schizophrenia, is feared for its ability to cause neutropenia and agranulocytosis. The frontline therapies for MM proteasome inhibitors, immunomodulatory drugs, and alkylating agents often hit the bone marrow just as hard. This review brings together what is currently known about their overlapping haematological toxicities, digs into the emerging signal that long-term clozapine exposure may itself raise the risk of a haematological malignancy, and offers practical, real-world strategies for threading this clinical needle. In the absence of formal guidelines, we argue that a truly functional multidisciplinary team, armed with a pre-agreed crisis plan, is not just helpful; it is the entire margin of safety.