Rings A, B and C are the phenanthrene ring system. This ring system has little conformational flexibility...
Two hydroxyl functional groups: a C3-phenolic [hydroxyl group] (pKa 9.9) and a C6-allylic [hydroxyl group],
An ether linkage between C4 and C5,
Unsaturation between C7 and C8,
A basic, [tertiary]-amine function at position 17, [and]
[Five]  centers  of  chirality  (C5,  C6,  C9,  C13  and  C14)  with  morphine  exhibiting  a  high  degree of stereoselectivity of analgesic action." Morphine and most of its derivatives do not exhibit optical isomerism, although some more distant relatives like the morphinan series (levorphanol, dextorphan and the racemic parent chemical racemorphan) do, and as noted above stereoselectivity in vivo is an important issue. Uses and derivatives
Most of the licit morphine produced is used to make codeine by methylation. It is also a precursor for many drugs including heroin (3,6-diacetylmorphine), hydromorphone (dihydromorphinone), and oxymorphone (14-hydroxydihydromorphinone). Most semi-synthetic opioids, both of the morphine and codeine subgroups, are created by modifying one or more of the following:
Halogenating or making other modifications at positions 1 or 2 on the morphine carbon skeleton. The methyl group that makes morphine into codeine can be removed or added back, or replaced with another functional group like ethyl and others to make codeine analogues of morphine-derived drugs and vice versa. Codeine analogues of morphine-based drugs often serve as prodrugs of the stronger drug, as in codeine and morphine, hydrocodone and hydromorphone, oxycodone and oxymorphone, nicocodeine and nicomorphine, dihydrocodeine and dihydromorphine, etc.
The most important and often life-saving treatment is the preventive therapy of granulocyte colony-stimulating factor (G-CSF), in the form of filgrastim, which regulates the production of neutrophils within the bone marrow, but shortens the neutropenic cycle to about 7-14 days and the duration of the severe condition. The subcutaneous injections, with median dosage of 1.5 μg/kg/day, can be given daily, intermittently once every three days, or timed to just treat the neutropenic period. The therapy is considered to be "safe and effective", with no significant adverse effects, besides a possibility of development of osteopenia.The granulocyte-macrophage colony-stimulating factor (GM-CSF) is less effective with more adverse effects. Another alternative is hematopoietic stem cell transplantation (HSCT), but is usually practiced in SCN, and in one case between two sibling donors, one of which was undergoing HSCT treatment for acute myeloid leukemia (AML) while the second had CyN and whose marrow was transferred, was also transferred CyN through allogeneic marrow grafting. It shows that CyN is a stem cell disorder. Yearly bone marrow examinations are not recommended. Prognosis
There is a very high risk of life-threatening infections and death at an early age. The quality of life and survival greatly improves with G-CSF treatment, which is practiced since the late 1980s. Unlike severe congenital neutropenia, individuals with cyclic neutropenia have a better response to G-CSF and do not have a risk of developing myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML).