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Pardanani A, Reichard K, Tefferi A. Advanced systemic mastocytosis-Revised classification, new drugs and how we treat. Br J Haematol 2024; 204:402-414. [PMID: 38054381 DOI: 10.1111/bjh.19245] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 11/19/2023] [Accepted: 11/24/2023] [Indexed: 12/07/2023]
Abstract
Mastocytosis constitutes the neoplastic proliferation of mast cells and is broadly classified into systemic mastocytosis (SM), cutaneous mastocytosis and mast cell sarcoma. SM is further partitioned into advanced (AdvSM) and non-advanced (SM-non-Adv) subcategories. AdvSM includes aggressive SM (ASM), SM with an associated haematological neoplasm (SM-AHN) and mast cell leukaemia (MCL). In 2022, two separate expert committees representing the 5th edition of the World Health Organization (WHO5) and the International Consensus (ICC) classification systems submitted revised classification criteria for SM, highlighted by the ICC-proposed incorporation of mast cell cytomorphology in the diagnostic criteria for MCL and myeloid-lineage restriction for the AHN component in SM-AHN. Recent developments in SM also include the introduction of KIT-targeting tyrosine kinase inhibitors (KITi), including midostaurin and avapritinib, both drugs have shown potent activity in reducing mast cell and mutant KIT burden and alleviating mast cell-associated organopathy and mediator symptoms; however, their overall impact on survival or superiority over pre-KITi era treatment options (e.g. cladribine) has not been studied in a controlled setting. In the current review, we provide a summary of recent changes in disease classification and an analysis of recent clinical trials and their impact on our current treatment approach in AdvSM.
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Affiliation(s)
| | - Kaaren Reichard
- Division of Hematopathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ayalew Tefferi
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
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Pardanani A. Systemic mastocytosis in adults: 2023 update on diagnosis, risk stratification and management. Am J Hematol 2023; 98:1097-1116. [PMID: 37309222 DOI: 10.1002/ajh.26962] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 04/29/2023] [Accepted: 05/02/2023] [Indexed: 06/14/2023]
Abstract
OVERVIEW Systemic mastocytosis (SM) results from clonal proliferation of mast cells (MC) in extracutaneous organs. DIAGNOSIS The major criterion is presence of multifocal MC clusters in the bone marrow and/or extracutaneous organs. Minor diagnostic criteria include elevated serum tryptase level, MC CD25/CD2/CD30 expression, and presence of activating KIT mutations. RISK STRATIFICATION Establishing SM subtype as per the International Consensus Classification/World Health Organization classification systems is an important first step. Patients either have indolent/smoldering SM (ISM/SSM) or advanced SM, including aggressive SM (ASM), SM with associated myeloid neoplasm (SM-AMN), and mast cell leukemia. Identification of poor-risk mutations (i.e., ASXL1, RUNX1, SRSF2, NRAS) further refines the risk stratification. Several risk models are available to help assign prognosis in SM patients. MANAGEMENT Treatment goals for ISM patients are primarily directed toward anaphylaxis prevention/symptom control/osteoporosis treatment. Patients with advanced SM frequently need MC cytoreductive therapy to reverse disease-related organ dysfunction. Tyrosine kinase inhibitors (TKI) (midostaurin, avapritinib) have changed the treatment landscape in SM. While deep biochemical, histological and molecular responses have been documented with avapritinib treatment, its efficacy as monotherapy against a multimutated AMN disease component in SM-AMN patients remains unclear. Cladribine continues to have a role for MC debulking, whereas interferon-α has a diminishing role in the TKI era. Treatment of SM-AMN primarily targets the AMN component, particularly if an aggressive disease such as acute leukemia is present. Allogeneic stem cell transplant has a role in such patients. Imatinib has a therapeutic role only in the rare patient with an imatinib-sensitive KIT mutation.
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Affiliation(s)
- Animesh Pardanani
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Efficacy of avapritinib versus best available therapy in the treatment of advanced systemic mastocytosis. Leukemia 2022; 36:2108-2120. [PMID: 35790816 PMCID: PMC9343245 DOI: 10.1038/s41375-022-01615-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/05/2022] [Accepted: 05/25/2022] [Indexed: 12/18/2022]
Abstract
Advanced systemic mastocytosis (AdvSM) is a rare myeloid neoplasm associated with poor overall survival (OS). This study (NCT04695431) compared clinical outcomes between patients with AdvSM treated with avapritinib in the Phase 1 EXPLORER (NCT0256198) and Phase 2 PATHFINDER (NCT03580655) trials (N = 176) and patients treated with best available therapy (BAT; N = 141). A multi-center, observational, retrospective chart review study was conducted at six study sites (four European, two American) to collect data from patients with AdvSM who received BAT; these data were pooled with data from EXPLORER and PATHFINDER. Comparisons between outcomes of OS, duration of treatment (DOT), and maximum reduction in serum tryptase were conducted between the treatment cohorts, with adjustment for key covariates. The results indicated that the avapritinib cohort had significantly better survival (adjusted hazard ratio (HR) (95% confidence interval (CI)): 0.48 (0.29, 0.79); p = 0.004) and significantly longer DOT (HR: 0.36 (0.26, 0.51); p < 0.001) compared to the BAT cohort. Additionally, the mean difference in percentage maximum reduction in serum tryptase levels was 60.3% greater in the avapritinib cohort (95% CI: −72.8, −47.9; p < 0.001). With no randomized controlled trials comparing avapritinib to BAT, these data offer crucial insights into the improved efficacy of avapritinib for the treatment of AdvSM.
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[Spectrum of gene mutations and clinical features in adult acute myeloid leukemia with normal karyotype]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2022; 43:420-423. [PMID: 34218586 PMCID: PMC9250958 DOI: 10.3760/cma.j.issn.0253-2727.2022.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Valent P, Akin C, Hartmann K, Alvarez-Twose I, Brockow K, Hermine O, Niedoszytko M, Schwaab J, Lyons JJ, Carter MC, Elberink HO, Butterfield JH, George TI, Greiner G, Ustun C, Bonadonna P, Sotlar K, Nilsson G, Jawhar M, Siebenhaar F, Broesby-Olsen S, Yavuz S, Zanotti R, Lange M, Nedoszytko B, Hoermann G, Castells M, Radia DH, Muñoz-Gonzalez JI, Sperr WR, Triggiani M, Kluin-Nelemans HC, Galli SJ, Schwartz LB, Reiter A, Orfao A, Gotlib J, Arock M, Horny HP, Metcalfe DD. Updated Diagnostic Criteria and Classification of Mast Cell Disorders: A Consensus Proposal. Hemasphere 2021; 5:e646. [PMID: 34901755 PMCID: PMC8659997 DOI: 10.1097/hs9.0000000000000646] [Citation(s) in RCA: 113] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 09/06/2021] [Indexed: 12/19/2022] Open
Abstract
Mastocytosis is a hematologic neoplasm characterized by expansion and focal accumulation of neoplastic mast cells (MC) in diverse organs, including the skin, bone marrow (BM), spleen, liver, and gastrointestinal tract. The World Health Organization classification divides the disease into prognostically distinct variants of cutaneous mastocytosis (CM) and systemic mastocytosis (SM). Although this classification remains valid, recent developments in the field and the advent of new diagnostic and prognostic parameters created a need to update and refine definitions and diagnostic criteria in MC neoplasms. In addition, MC activation syndromes (MCAS) and genetic features predisposing to SM and MCAS have been identified. To discuss these developments and refinements in the classification, we organized a Working Conference comprised of experts from Europe and the United States in August 2020. This article reports on outcomes from this conference. Of particular note, we propose adjustments in the classification of CM and SM, refinements in diagnostic criteria of SM variants, including smoldering SM and BM mastocytosis (BMM), and updated criteria for MCAS and other conditions involving MC. CD30 expression in MC now qualifies as a minor SM criterion, and BMM is now defined by SM criteria, absence of skin lesions and absence of B- and C-findings. A basal serum tryptase level exceeding 20 ng/mL remains a minor SM criterion, with recognition that hereditary alpha-tryptasemia and various myeloid neoplasms may also cause elevations in tryptase. Our updated proposal will support diagnostic evaluations and prognostication in daily practice and the conduct of clinical trials in MC disorders.
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Affiliation(s)
- Peter Valent
- Division of Hematology and Hemostaseology, Department of Internal Medicine I, Medical University of Vienna, Austria
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Austria
| | - Cem Akin
- Division of Allergy and Clinical Immunology, University of Michigan, Ann Arbor, Michigan, USA
| | - Karin Hartmann
- Division of Allergy, Department of Dermatology, University Hospital Basel and University of Basel, Switzerland
- Department of Biomedicine, University Hospital Basel and University of Basel, Switzerland
| | - Ivan Alvarez-Twose
- Instituto de Estudios de Mastocitosis de Castilla La Mancha (CLMast) and CIBERONC, Hospital Virgen del Valle, Toledo, Spain
| | - Knut Brockow
- Department of Dermatology and Allergy Biederstein, Technical University of Munich, Germany
| | - Olivier Hermine
- Imagine Institute Université de Paris, Sorbonne, Institut national de la santé et de la recherche médicale U1163, Centre national de référence des mastocytoses, Hôpital Necker, Assistance publique hôpitaux de Paris, France
| | | | - Juliana Schwaab
- Department of Hematology and Oncology, University Hospital Mannheim, Germany
| | - Jonathan J. Lyons
- Translational Allergic Immunopathology Unit, Laboratory of Allergic Diseases, NIAID, NIH, Bethesda, Maryland, USA
| | - Melody C. Carter
- Mast Cell Biology Section, Laboratory of Allergic Diseases, NIAID, NIH, Bethesda, Maryland, USA
| | - Hanneke Oude Elberink
- Department of Allergology, University Medical Center Groningen and GRIAC Research Institute, University of Groningen, The Netherlands
| | | | - Tracy I. George
- Department of Pathology, University of Utah, Salt Lake City, Utah, USA
| | - Georg Greiner
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Austria
- Department of Laboratory Medicine, Medical University of Vienna, Austria and Ihr Labor, Medical Diagnostic Laboratories, Vienna, Austria
| | - Celalettin Ustun
- Division of Hematology, Oncology and Cell Therapy, Department of Medicine, The Coleman Foundation Blood and Marrow Transplant Center at Rush University Medical Center, Chicago, Illinois, USA
| | | | - Karl Sotlar
- Institute of Pathology, Paracelsus Medical University Salzburg, Austria
| | - Gunnar Nilsson
- Department of Medicine Solna & Mastocytosis Centre, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Mohamad Jawhar
- Department of Hematology and Oncology, University Hospital Mannheim, Germany
| | - Frank Siebenhaar
- Dermatological Allergology, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt - Universität zu Berlin, and Berlin Institute of Health, Germany
| | - Sigurd Broesby-Olsen
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark
| | - Selim Yavuz
- Division of Haematology, Department of Internal Medicine, University of Istanbul, Turkey
| | - Roberta Zanotti
- Section of Hematology, Multidisciplinary Outpatients Clinics for Mastocytosis, Department of Medicine, University Hospital of Verona, Italy
| | - Magdalena Lange
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, Poland
| | - Boguslaw Nedoszytko
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, Poland
- Invicta Fertility and Reproductive Center, Molecular Laboratory, Sopot, Poland
| | - Gregor Hoermann
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Austria
- MLL Munich Leukemia Laboratory, Munich, Germany
| | - Mariana Castells
- Division of Allergy and Immunology, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Deepti H. Radia
- Department of Clinical Haematology, Guys and St Thomas’ NHS Hospitals, London, United Kingdom
| | - Javier I. Muñoz-Gonzalez
- Servicio Central de Citometria, Centro de Investigacion del Cancer (IBMCC; CSIC/USAL) Instituto Biosanitario de Salamanca (IBSAL) and Department of Medicine, University of Salamanca, Spain
| | - Wolfgang R. Sperr
- Division of Hematology and Hemostaseology, Department of Internal Medicine I, Medical University of Vienna, Austria
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Austria
| | - Massimo Triggiani
- Division of Allergy and Clinical Immunology, University of Salerno, Italy
| | - Hanneke C. Kluin-Nelemans
- Department of Haematology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Stephen J. Galli
- Department of Pathology and the Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, California, USA
| | - Lawrence B. Schwartz
- Division of Rheumatology, Allergy & Immunology, Department of Internal Medicine, Virginia Commonwealth University (VCU), Richmond, Virginia, USA
| | - Andreas Reiter
- Department of Hematology and Oncology, University Hospital Mannheim, Germany
| | - Alberto Orfao
- Servicio Central de Citometria, Centro de Investigacion del Cancer (IBMCC; CSIC/USAL) Instituto Biosanitario de Salamanca (IBSAL) and Department of Medicine, University of Salamanca, Spain
| | - Jason Gotlib
- Stanford Cancer Institute/Stanford University School of Medicine/Stanford Cancer Institute, Stanford, California, USA
| | - Michel Arock
- Department of Hematological Biology, Pitié-Salpêtrière Hospital, Pierre et Marie Curie University (UPMC), Paris, France
| | - Hans-Peter Horny
- Institute of Pathology, Paracelsus Medical University Salzburg, Austria
- Institute of Pathology, Ludwig-Maximilians-University, Munich, Germany
| | - Dean D. Metcalfe
- Mast Cell Biology Section, Laboratory of Allergic Diseases, NIAID, NIH, Bethesda, Maryland, USA
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Precision Medicine in Systemic Mastocytosis. Medicina (B Aires) 2021; 57:medicina57111135. [PMID: 34833353 PMCID: PMC8623914 DOI: 10.3390/medicina57111135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 12/20/2022] Open
Abstract
Mastocytosis is a rare hematological neoplasm characterized by the proliferation of abnormal clonal mast cells (MCs) in different cutaneous and extracutaneous organs. Its diagnosis is based on well-defined major and minor criteria, including the pathognomonic dense infiltrate of MCs detected in bone marrow (BM), elevated serum tryptase level, abnormal MCs CD25 expression, and the identification of KIT D816V mutation. The World Health Organization (WHO) classification subdivides mastocytosis into a cutaneous form (CM) and five systemic variants (SM), namely indolent/smoldering (ISM/SSM) and advanced SM (AdvSM) including aggressive SM (ASM), SM associated to hematological neoplasms (SM-AHN), and mast cell leukemia (MCL). More than 80% of patients with SM carry a somatic point mutation of KIT at codon 816, which may be targeted by kinase inhibitors. The presence of additional somatic mutations detected by next generation sequencing analysis may impact prognosis and drive treatment strategy, which ranges from symptomatic drugs in indolent forms to kinase-inhibitors active on KIT. Allogeneic stem cell transplant (SCT) may be considered in selected SM cases. Here, we review the clinical, diagnostic, and therapeutic issues of SM, with special emphasis on the translational implications of SM genetics for a precision medicine approach in clinical practice.
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Systemic Mastocytosis: Molecular Landscape and Implications for Treatment. Mediterr J Hematol Infect Dis 2021; 13:e2021046. [PMID: 34276915 PMCID: PMC8265368 DOI: 10.4084/mjhid.2021.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 06/11/2021] [Indexed: 12/04/2022] Open
Abstract
Over the past decade, we have witnessed significant advances in the molecular characterization of systemic mastocytosis (SM). This has provided important information for a better understanding of the pathogenesis of the disease but has also practically impacted the way we diagnose and manage it. Advances in molecular testing have run in parallel with advances in therapeutic targeting of constitutive active KIT, the major driver of the disease. Therefore, assessing the molecular landscape in each SM patient is essential for diagnosis, prognosis, treatment, and therapeutic efficacy monitoring. This is facilitated by the routine availability of novel technologies like digital PCR and NGS. This review aims to summarize the pathogenesis of the disease, discuss the value of molecular diagnostic testing and how it should be performed, and provide an overview of present and future therapeutic concepts based on fine molecular characterization of SM patients.
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Pardanani A. Systemic mastocytosis in adults: 2021 Update on diagnosis, risk stratification and management. Am J Hematol 2021; 96:508-525. [PMID: 33524167 DOI: 10.1002/ajh.26118] [Citation(s) in RCA: 86] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 01/08/2021] [Indexed: 12/16/2022]
Abstract
OVERVIEW Systemic mastocytosis (SM) results from a clonal proliferation of abnormal mast cells (MC) in extra-cutaneous organs. DIAGNOSIS The major criterion is presence of multifocal clusters of spindled MC in the bone marrow. Minor diagnostic criteria include elevated serum tryptase level, abnormal MC CD25 expression, and presence of KITD816V mutation. RISK STRATIFICATION Establishing SM subtype as per the World Health Organization classification system is an important first step. Broadly, patients either have indolent/smoldering SM (ISM/SSM) or advanced SM, the latter includes aggressive SM (ASM), SM with associated hematological neoplasm (SM-AHN), and mast cell leukemia (MCL). Identification of poor-risk mutations (ie, ASXL1, RUNX1, SRSF2, NRAS) further refines the risk stratification. Recently, clinical and hybrid clinical-molecular risk models have been developed to more accurately assign prognosis in SM patients. MANAGEMENT Treatment goals for ISM patients are primarily directed towards anaphylaxis prevention/symptom control/osteoporosis treatment. Patients with advanced SM frequently need MC cytoreductive therapy to ameliorate disease-related organ dysfunction. High response rates have been seen with small-molecule inhibitors that target mutant-KIT, including midostaurin (Food and Drug Administration approved) or avapritinib (investigational). Other options for MC cytoreduction include cladribine or interferon-α, although head-to-head comparisons are lacking. Treatment of SM-AHN primarily targets the AHN component, particularly if an aggressive disease such as acute myeloid leukemia is present. Allogeneic stem cell transplant can be considered in such patients, or in those with relapsed/refractory advanced SM. Imatinib has a limited therapeutic role in SM; effective cytoreduction is limited to those with imatinib-sensitive KIT mutations.
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Affiliation(s)
- Animesh Pardanani
- Division of Hematology, Department of Medicine Mayo Clinic Rochester Minnesota
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Szudy-Szczyrek A, Bachanek-Mitura O, Gromek T, Chromik K, Mital A, Szczyrek M, Krupski W, Szumiło J, Kanduła Z, Helbig G, Hus M. Real-World Efficacy of Midostaurin in Aggressive Systemic Mastocytosis. J Clin Med 2021; 10:jcm10051109. [PMID: 33799933 PMCID: PMC7961806 DOI: 10.3390/jcm10051109] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/27/2021] [Accepted: 03/04/2021] [Indexed: 01/08/2023] Open
Abstract
In April 2017 midostaurin was approved by the US Food and Drug Administration for the treatment of patients with aggressive systemic mastocytosis (ASM). So far, very limited real world data on its efficacy is available. Thirteen patients aged from 48 to 79 years, who received midostaurin in the early access program, were included in the study. Midostaurin was used both in first (n = 5) and subsequent lines of treatment (n = 8). The median duration of exposure was 9 months. Most patients (77%, n = 10) had a clinical improvement already as soon as the second month of therapy. Objective response was noted in 4 (50%) of eight evaluated patients. Among responders, we observed a decrease in serum tryptase level (median 74.14%) and bone marrow infiltration by mast cells (median 50%) in the sixth month of treatment. In one case, in the 10th month of treatment, allogenic stem cell transplantation was performed, achieving complete remission. Five patients died, three due to progression of disease, one in the course of secondary acute myeloid leukemia and one due to reasons not related to mastocytosis. Treatment is ongoing in seven patients. We found that midostaurin therapy is beneficial to patients with ASM.
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Affiliation(s)
- Aneta Szudy-Szczyrek
- Chair and Department of Haematooncology and Bone Marrow Transplantation, Medical University of Lublin Staszica Street 11, 20-081 Lublin, Poland; (O.B.-M.); (T.G.)
- Correspondence: (A.S.-S.); (M.H.)
| | - Oliwia Bachanek-Mitura
- Chair and Department of Haematooncology and Bone Marrow Transplantation, Medical University of Lublin Staszica Street 11, 20-081 Lublin, Poland; (O.B.-M.); (T.G.)
| | - Tomasz Gromek
- Chair and Department of Haematooncology and Bone Marrow Transplantation, Medical University of Lublin Staszica Street 11, 20-081 Lublin, Poland; (O.B.-M.); (T.G.)
| | - Karolina Chromik
- Department of Hematology and Bone Marrow Transplantation, Medical University of Silesia in Katowice, 40-032 Katowice, Poland; (K.C.); (G.H.)
| | - Andrzej Mital
- Department of Hematology and Transplantology, Medical University of Gdańsk, 80-211 Gdańsk, Poland;
| | - Michał Szczyrek
- Chair and Department of Pneumonology, Oncology and Allergology, Medical University of Lublin, 20-090 Lublin, Poland;
| | - Witold Krupski
- II Department of Medical Radiology, Medical University of Lublin, 20-081 Lublin, Poland;
| | - Justyna Szumiło
- Chair and Department of Clinical Pathomorphology, Medical University of Lublin, 20-090 Lublin, Poland;
| | - Zuzanna Kanduła
- Department of Hematology and Bone Marrow Transplantation, University of Medical Sciences in Poznan, 61-001 Poznań, Poland;
| | - Grzegorz Helbig
- Department of Hematology and Bone Marrow Transplantation, Medical University of Silesia in Katowice, 40-032 Katowice, Poland; (K.C.); (G.H.)
| | - Marek Hus
- Chair and Department of Haematooncology and Bone Marrow Transplantation, Medical University of Lublin Staszica Street 11, 20-081 Lublin, Poland; (O.B.-M.); (T.G.)
- Correspondence: (A.S.-S.); (M.H.)
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Arun VA, Soni D, Bal A, Jain A. Aggressive systemic mastocytosis presenting as rapidly progressive ascites, generalised lymphadenopathy and osteosclerosis. BMJ Case Rep 2021; 14:14/2/e238034. [PMID: 33558379 PMCID: PMC7872913 DOI: 10.1136/bcr-2020-238034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Rapidly progressive ascites is a frequent clinical manifestation of advanced abdominal malignancies or portal hypertension due to liver diseases. We report a case of 61-year-old man who presented with rapidly progressive ascites. The presence of ascites, generalised lymphadenopathy, osteosclerosis on imaging and hepatosplenomegaly initially pointed towards the diagnosis of advanced high-grade lymphoma or accelerated myeloid neoplasm. Lymph node biopsy revealed infiltration by CD45, cKIT and CD30; tryptase and toluidine blue-positive mast cells (MCs). Bone marrow examination revealed infiltration by MCs and next generation sequencing revealed the pathognomic exon 17 D 816V KIT mutation. The patient was started on weekly pegylated interferon with significant symptom relief. Systemic mastocytosis should be considered as a differential diagnosis in a clinical case of ascites of unknown aetiology even in the absence of typical skin manifestations.
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Affiliation(s)
| | - Dipesh Soni
- Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Amanjit Bal
- Department of Histopathology, PGIMER, Chandigarh, India
| | - Arihant Jain
- Department of Internal Medicine, PGIMER, Chandigarh, India
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Mast Cell Activation Disorders. ACTA ACUST UNITED AC 2021; 57:medicina57020124. [PMID: 33573161 PMCID: PMC7911219 DOI: 10.3390/medicina57020124] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/23/2021] [Accepted: 01/27/2021] [Indexed: 02/07/2023]
Abstract
Background and Objectives: Mast cell disorders comprise a wide spectrum of syndromes caused by mast cells' degranulation with acute or chronic clinical manifestations. Materials and Methods: In this review article we reviewed the latest findings in scientific papers about mast cell disorders with a particular focus on mast cell activation syndrome and mastocytosis in pediatric age. Results: Patients with mast cell activation syndrome have a normal number of mast cells that are hyperreactive upon stimulation of various triggers. We tried to emphasize the diagnostic criteria, differential diagnosis, and therapeutic strategies. Another primary mast cell disorder is mastocytosis, a condition with a long-known disease, in which patients have an increased number of mast cells that accumulate in different regions of the body with different clinical evolution in pediatric age. Conclusions: Mast cell activation syndrome overlaps with different clinical entities. No consensus was found on biomarkers and no clearly resolutive treatment is available. Therefore, a more detailed knowledge of this syndrome is of fundamental importance for a correct diagnosis and effective therapy.
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Ozturk K, Cayci Z, Gotlib J, Akin C, George TI, Ustun C. Non-hematologic diagnosis of systemic mastocytosis: Collaboration of radiology and pathology. Blood Rev 2020; 45:100693. [PMID: 32334853 DOI: 10.1016/j.blre.2020.100693] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 01/28/2020] [Accepted: 04/02/2020] [Indexed: 11/19/2022]
Abstract
Systemic mastocytosis (SM) is a hematologic disease with a wide range of clinical courses ranging from an indolent condition with normal life expectancy to exceedingly aggressive disorder with a poor prognosis. The symptoms and signs of SM result from the release of mast cell mediators with heterogeneous functions, and/or organ damage from neoplastic mast cell infiltration, or both. Diagnostic criteria for SM are well-defined by the World Health Organization (WHO). However, the diagnosis of SM can be difficult when especially it is not in the differential diagnosis. Routinely used radiologic techniques (e.g., X-ray, ultrasound, CT scans can show findings such as lytic-, sclerotic- or mixed-bone lesions, splenomegaly, hepatomegaly, retroperitoneal or periportal mesenteric lymphadenopathy, and omental thickening). It is essential to emphasize that the constellation of these radiologic findings should strongly concern of SM, especially in patients who also have a skin rash, allergic reactions, gastrointestinal tract symptoms (lasting, intermittent nausea, diarrhea), paroxysmal tachycardias, unexplained weight loss, persistent bone pain, cytopenias, liver dysfunction, eosinophilia. These findings, even coincidentally noted, will likely lead to a tissue biopsy, which reveals diagnosis (as we discussed and illustrated some tissue biopsies here). Moreover, the role of MRI and new techniques such as [18-fluorodeoxyglucose positron emission computed tomography, fibroscan] in the diagnosis of SM have been discussed. Furthermore, we reviewed the use of radiologic methods to evaluate treatment response and prognostication of SM..
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Affiliation(s)
- Kerem Ozturk
- Department of Radiology, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Zuzan Cayci
- Department of Radiology, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Jason Gotlib
- Division of Hematology, Stanford Cancer Institute, Stanford University School of Medicine, CA, USA
| | - Cem Akin
- Division of Allergy and Clinical Immunology, University of Michigan, Ann Arbor, MI, USA
| | - Tracy I George
- Department of Pathology, University of Utah, Salt Lake City, UT, USA
| | - Celalettin Ustun
- Division of Hematology, Oncology and Cellular Therapy, Department of Medicine, Rush University, Chicago, IL, USA.
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13
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Laforgia M, Calabrò C, Scattone A, Laface C, Porcelli M, Gadaleta CD, Nardulli P, Ranieri G. Pharmacotherapy in Mast Cell Leukemia. Expert Opin Pharmacother 2020; 21:1059-1069. [PMID: 32208985 DOI: 10.1080/14656566.2020.1744566] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Mast cell leukemia (MCL) is one of the most aggressive forms of Systemic Mastocytosis (SM), a complex family of rare diseases, for which standard therapies are very few. MCL represents only <1% cases of SM and this is the reason why there are no specific clinical trials to better explore this disease. As a consequence, MCL is treated and grouped within other forms of SM, being all KIT-driven diseases; however, its KIT dysregulation leads to uncontrolled activation of mast cells (MCs), which correlates with forms of myeloid acute leukemia (AML). AREAS COVERED Different therapeutic approaches can be followed in the treatment of MCL. The authors look at both symptomatic therapies along with other approaches including targeted therapy. Further, the authors provide their expert opinion. EXPERT OPINION In the scenario of mast cell leukemia treatment, the key approach to achieve clinical results is, more than other similar pathologies, personalizing the therapy. It could be interesting or desirable to introduce for instance KIT mutant forms as minor criteria for the diagnosis of advanced SM, considering the small patient population with MCL and the relatively large panel of activating mutations for KIT and other important proteins involved in MCs' regulation.
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Affiliation(s)
- Mariarita Laforgia
- S.C. Farmacia e U.Ma.C.A, IRCCS Istituto Tumori Giovanni Paolo II , Bari, Italy
| | - Concetta Calabrò
- S.C. Farmacia e U.Ma.C.A, IRCCS Istituto Tumori Giovanni Paolo II , Bari, Italy
| | - Anna Scattone
- Anatomo-Pathology Department, IRCCS Istituto Tumori "Giovanni Paolo II" , Bari, Italy
| | - Carmelo Laface
- Department of Interventional Radiology and Integrated Medical Oncology, IRCCS Istituto Tumori "Giovanni Paolo II" , Bari, Italy
| | - Mariangela Porcelli
- Department of Interventional Radiology and Integrated Medical Oncology, IRCCS Istituto Tumori "Giovanni Paolo II" , Bari, Italy
| | - Cosmo Damiano Gadaleta
- Department of Interventional Radiology and Integrated Medical Oncology, IRCCS Istituto Tumori "Giovanni Paolo II" , Bari, Italy
| | - Patrizia Nardulli
- S.C. Farmacia e U.Ma.C.A, IRCCS Istituto Tumori Giovanni Paolo II , Bari, Italy
| | - Girolamo Ranieri
- Department of Interventional Radiology and Integrated Medical Oncology, IRCCS Istituto Tumori "Giovanni Paolo II" , Bari, Italy
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14
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Multidisciplinary Challenges in Mastocytosis and How to Address with Personalized Medicine Approaches. Int J Mol Sci 2019; 20:ijms20122976. [PMID: 31216696 PMCID: PMC6627900 DOI: 10.3390/ijms20122976] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/05/2019] [Accepted: 06/16/2019] [Indexed: 12/27/2022] Open
Abstract
Mastocytosis is a hematopoietic neoplasm defined by abnormal expansion and focal accumulation of clonal tissue mast cells in various organ-systems. The disease exhibits a complex pathology and an equally complex clinical behavior. The classification of the World Health Organization (WHO) divides mastocytosis into cutaneous forms, systemic variants, and localized mast cell tumors. In >80% of patients with systemic mastocytosis (SM), a somatic point mutation in KIT at codon 816 is found. Whereas patients with indolent forms of the disease have a normal or near-normal life expectancy, patients with advanced mast cell neoplasms, including aggressive SM and mast cell leukemia, have a poor prognosis with short survival times. In a majority of these patients, multiple somatic mutations and/or an associated hematologic neoplasm, such as a myeloid leukemia, may be detected. Independent of the category of mastocytosis and the serum tryptase level, patients may suffer from mediator-related symptoms and/or osteopathy. Depending on the presence of co-morbidities, the symptomatology in such patients may be mild, severe or even life-threatening. Most relevant co-morbidities in such patients are IgE-dependent allergies, psychiatric, psychological or mental problems, and vitamin D deficiency. The diagnosis and management of mastocytosis is an emerging challenge in clinical practice and requires vast knowledge, a multidisciplinary approach, and personalized medicine procedures. In this article, the current knowledge about mastocytosis is reviewed with special emphasis on the multidisciplinary aspects of the disease and related challenges in daily practice.
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15
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Castells M, Butterfield J. Mast Cell Activation Syndrome and Mastocytosis: Initial Treatment Options and Long-Term Management. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:1097-1106. [DOI: 10.1016/j.jaip.2019.02.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/04/2019] [Accepted: 02/04/2019] [Indexed: 02/06/2023]
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16
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Budnik J, Milano MT. A registry-based analysis of survival outcomes in mast cell leukemia. Leuk Res 2019; 78:24-28. [DOI: 10.1016/j.leukres.2019.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 01/11/2019] [Accepted: 01/12/2019] [Indexed: 01/08/2023]
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17
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Willmann M, Hadzijusufovic E, Hermine O, Dacasto M, Marconato L, Bauer K, Peter B, Gamperl S, Eisenwort G, Jensen-Jarolim E, Müller M, Arock M, Vail DM, Valent P. Comparative oncology: The paradigmatic example of canine and human mast cell neoplasms. Vet Comp Oncol 2018; 17:1-10. [PMID: 30136349 PMCID: PMC6378619 DOI: 10.1111/vco.12440] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 08/14/2018] [Accepted: 08/16/2018] [Indexed: 12/13/2022]
Abstract
In humans, advanced mast cell (MC) neoplasms are rare malignancies with a poor prognosis. Only a few preclinical models are available, and current treatment options are limited. In dogs, MC neoplasms are the most frequent malignant skin tumours. Unlike low‐grade MC neoplasms, high‐grade MC disorders usually have a poor prognosis with short survival. In both species, neoplastic MCs display activating KIT mutations, which are considered to contribute to disease evolution. Therefore, tyrosine kinase inhibitors against KIT have been developed. Unfortunately, clinical responses are unpredictable and often transient, which remains a clinical challenge in both species. Therefore, current efforts focus on the development of new improved treatment strategies. The field of comparative oncology may assist in these efforts and accelerate human and canine research regarding diagnosis, prognostication, and novel therapies. In this article, we review the current status of comparative oncology approaches and perspectives in the field of MC neoplasms.
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Affiliation(s)
- Michael Willmann
- Department of Companion Animals and Horses, Clinic for Internal Medicine, University of Veterinary Medicine Vienna, Vienna, Austria.,Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria
| | - Emir Hadzijusufovic
- Department of Companion Animals and Horses, Clinic for Internal Medicine, University of Veterinary Medicine Vienna, Vienna, Austria.,Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria.,Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Olivier Hermine
- Department of Hematology, Necker Hospital, Imagine Institute Université Paris Descartes, Sorbonne, Paris, France
| | - Mauro Dacasto
- Department of Comparative Biomedicine and Food Science, University of Padua, Padua, Italy
| | | | - Karin Bauer
- Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria.,Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Barbara Peter
- Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria.,Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Susanne Gamperl
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Gregor Eisenwort
- Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria.,Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Erika Jensen-Jarolim
- Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria.,The Interuniversity Messerli Research Institute, University of Veterinary Medicine Vienna, Medical University Vienna, University of Vienna, Vienna, Austria
| | - Mathias Müller
- Biomodels Austria and Institute of Animal Breeding and Genetics, University of Veterinary Medicine, Vienna, Austria
| | - Michel Arock
- LBPA CNRS UMR8113, Ecole Normale Supérieure de Cachan, Cachan, France.,Laboratory of Hematology, Pitié-Salpêtrière Hospital, Paris, France
| | - David M Vail
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin.,Carbone Cancer Center, University of Wisconsin-Madison, Madison, Wisconsin
| | - Peter Valent
- Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria.,Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
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18
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Aggressive Systemic Mastocytosis in Association with Pure Red Cell Aplasia. Case Rep Hematol 2018; 2018:6928571. [PMID: 30069418 PMCID: PMC6057401 DOI: 10.1155/2018/6928571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/20/2018] [Accepted: 06/20/2018] [Indexed: 01/08/2023] Open
Abstract
Aggressive systemic mastocytosis (ASM) is characterized by mast cell accumulation in systemic organs. Though ASM may be associated with other hematological disorders, the association with pure red cell aplasia (PRCA) is rare and has not been reported. Pure red cell aplasia (PRCA) is a syndrome, characterized by normochromic normocytic anemia, reticulocytopenia, and severe erythroid hypoplasia. The myeloid and megakaryocytic cell lines usually remain normal. Here, we report an unusual case of ASM, presenting in association with PRCA and the management challenges.
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19
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Schlenk RF, Kayser S. Midostaurin: A Multiple Tyrosine Kinases Inhibitor in Acute Myeloid Leukemia and Systemic Mastocytosis. Recent Results Cancer Res 2018; 212:199-214. [PMID: 30069632 DOI: 10.1007/978-3-319-91439-8_10] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Midostaurin (PKC412, Rydapt®) is an oral multiple tyrosine kinase inhibitor. Main targets are the kinase domain receptor, vascular endothelial-, platelet derived-, and fibroblast growth factor receptor, stem cell factor receptor c-KIT, as well as mutated and wild-type FLT3 kinases. Midostaurin was approved by the Food and Drug Administration (FDA) and the European Medical Agency (EMA) for acute myeloid leukemia with activating FLT3 mutations in combination with intensive induction and consolidation therapy as well as aggressive systemic mastocytosis (ASM), systemic mastocytosis with associated hematological neoplasm (SM-AHN) or mast cell leukemia (MCL). Several clinical trials are active or are planned to further investigate the role of midostaurin in myeloid malignancies and mastocytosis.
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Affiliation(s)
- Richard F Schlenk
- NCT-Trial Center, German Cancer Research Center, Heidelberg, Germany.
| | - Sabine Kayser
- Department of Internal Medicine V, University Hospital of Heidelberg, Heidelberg, Germany.,Clinical Cooperation Unit Molecular Hematology/Oncology, German Cancer Research Center (DKFZ), University of Heidelberg, Heidelberg, Germany
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20
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Kayser S, Levis MJ, Schlenk RF. Midostaurin treatment in FLT3-mutated acute myeloid leukemia and systemic mastocytosis. Expert Rev Clin Pharmacol 2017; 10:1177-1189. [PMID: 28960095 DOI: 10.1080/17512433.2017.1387051] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION A number of tyrosine kinase inhibitors (TKIs) have been developed that inhibit the constitutively activated kinase activity caused by activating tyrosine kinase mutations, such as FLT3 or KIT, thus interrupting signaling pathways. Currently, midostaurin is the only approved TKI as monotherapy for aggressive systemic mastocytosis (SM), SM with associated hematological neoplasm, or mast cell leukemia displaying a KIT mutation as well as in combination with standard intensive chemotherapy for adult patients with newly diagnosed FLT3-mutated acute myeloid leukemia (AML). Areas covered: We provide a concise review of the pharmacology, tolerability and clinical efficacy of midostaurin and emerging new treatment options for ASM and FLT3-mutated AML. Expert commentary: Currently, midostaurin is the only approved TKI in aggressive SM, SM with associated hematological neoplasm, or mast cell leukemia inducing responses including complete remissions. With regard to AML, midostaurin is the first drug to receive regulatory approval in this indication in the molecularly defined subgroup of AML with FLT3 mutations. By introduction of this new standard in AML with FLT3 mutations, the bare has been raised for future approvals of next generation FLT3 inhibitors which will be based increasingly on head to head comparisons with midostaurin.
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Affiliation(s)
- Sabine Kayser
- a Department of Internal Medicine V , University Hospital of Heidelberg , Heidelberg , Germany.,b Clinical Cooperation Unit Molecular Hematology/Oncology , German Cancer Research Center (DKFZ) and Department of Internal Medicine V, University of Heidelberg , Heidelberg , Germany
| | - Mark J Levis
- c Sidney Kimmel Comprehensive Cancer Center , Johns Hopkins University , Baltimore , MD , USA
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21
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DeAngelo DJ, George TI, Linder A, Langford C, Perkins C, Ma J, Westervelt P, Merker JD, Berube C, Coutre S, Liedtke M, Medeiros B, Sternberg D, Dutreix C, Ruffie PA, Corless C, Graubert TJ, Gotlib J. Efficacy and safety of midostaurin in patients with advanced systemic mastocytosis: 10-year median follow-up of a phase II trial. Leukemia 2017; 32:470-478. [PMID: 28744009 DOI: 10.1038/leu.2017.234] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 07/02/2017] [Accepted: 07/10/2017] [Indexed: 01/08/2023]
Abstract
Patients with advanced systemic mastocytosis (SM) (e.g. aggressive SM (ASM), SM with an associated hematologic neoplasm (SM-AHN) and mast cell leukemia (MCL)) have limited treatment options and exhibit reduced survival. Midostaurin is an oral multikinase inhibitor that inhibits D816V-mutated KIT, a primary driver of SM pathogenesis. We conducted a phase II trial of midostaurin 100 mg twice daily, administered as 28-day cycles, in 26 patients (ASM, n=3; SM-AHN, n= 17; MCL, n=6) with at least one sign of organ damage. During the first 12 cycles, the overall response rate was 69% (major/partial response: 50/19%) with clinical benefit in all advanced SM variants. With ongoing therapy, 2 patients achieved a complete remission of their SM. Midostaurin produced a ⩾50% reduction in bone marrow mast cell burden and serum tryptase level in 68% and 46% of patients, respectively. Median overall survival for the entire cohort was 40 months, and 18.5 months for MCL patients. Low-grade gastrointestinal side effects were common and manageable with antiemetics. The most frequent grade 3/4 nonhematologic and hematologic toxicities were asymptomatic hyperlipasemia (15%) and anemia (12%). With median follow-up of 10 years, no unexpected toxicities emerged. These data establish the durable activity and tolerability of midostaurin in advanced SM.
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Affiliation(s)
- D J DeAngelo
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - T I George
- Department of Pathology, University of New Mexico, Albuquerque, NM, USA
| | - A Linder
- Division of Hematology, Department of Medicine, Stanford University School of Medicine/Stanford Cancer Institute, Stanford, CA, USA
| | - C Langford
- Division of Hematology, Department of Medicine, Stanford University School of Medicine/Stanford Cancer Institute, Stanford, CA, USA
| | - C Perkins
- Division of Hematology, Department of Medicine, Stanford University School of Medicine/Stanford Cancer Institute, Stanford, CA, USA
| | - J Ma
- Division of Hematology, Department of Medicine, Stanford University School of Medicine/Stanford Cancer Institute, Stanford, CA, USA
| | - P Westervelt
- Division of Hematology/Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - J D Merker
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - C Berube
- Division of Hematology, Department of Medicine, Stanford University School of Medicine/Stanford Cancer Institute, Stanford, CA, USA
| | - S Coutre
- Division of Hematology, Department of Medicine, Stanford University School of Medicine/Stanford Cancer Institute, Stanford, CA, USA
| | - M Liedtke
- Division of Hematology, Department of Medicine, Stanford University School of Medicine/Stanford Cancer Institute, Stanford, CA, USA
| | - B Medeiros
- Division of Hematology, Department of Medicine, Stanford University School of Medicine/Stanford Cancer Institute, Stanford, CA, USA
| | - D Sternberg
- Novartis Pharmaceuticals, Florham Park, NJ, USA.,Novartis Pharmaceuticals, Basel, Switzerland
| | - C Dutreix
- Novartis Pharmaceuticals, Florham Park, NJ, USA.,Novartis Pharmaceuticals, Basel, Switzerland
| | - P-A Ruffie
- Novartis Pharmaceuticals, Florham Park, NJ, USA.,Novartis Pharmaceuticals, Basel, Switzerland
| | - C Corless
- Department of Pathology, Oregon Health and Sciences University, Portland, OR, USA
| | - T J Graubert
- Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - J Gotlib
- Division of Hematology, Department of Medicine, Stanford University School of Medicine/Stanford Cancer Institute, Stanford, CA, USA
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22
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Chandesris MO, Damaj G, Lortholary O, Hermine O. Clinical potential of midostaurin in advanced systemic mastocytosis. BLOOD AND LYMPHATIC CANCER-TARGETS AND THERAPY 2017; 7:25-35. [PMID: 31360083 PMCID: PMC6467340 DOI: 10.2147/blctt.s87186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Advanced (Ad) systemic mastocytoses (SM) include aggressive SM (ASM) and mast cell leukemia (MCL) with or without an associated clonal hematological non-mast cell lineage disease (AHNMD). They are rare (<15%) but are associated with a poor prognosis due to rapid organ dysfunction. To date, responses to high-dose chemotherapy, cladribine, and imatinib were revealed to be suboptimal with a median survival time of 24 months. Midostaurin is a potent multikinase inhibitor including the most frequent KIT D816V mutation (>80%). We herein present a review of the most recent data of the use of midostaurin in AdSM. First, a multicenter Phase II study (CPKC412D2213) revealed an unprecedented overall response rate (ORR) of 69% regardless of KIT mutational status, with 38% of major response (MR) among 26 AdSM patients treated with midostaurin alone 200 mg daily. Second, a sponsor-initiated, multicenter, single-arm open Phase II study (CPKC412D2201) confirmed a high and durable ORR of 60% including 45% of MR among 89 AdSM patients. Finally, a French compassionate use program managed by the French Reference Centre for Mastocytosis allowed the treatment of almost a hundred AdSM patients to date in France since the CPKC412D2201 study closure. The outcome of the first 28 treated patients under cover of this on-going procedure revealed an ORR of 71% including 57% of MR. Most importantly, survival analysis revealed in comparison to a historical control cohort of AdSM patients who did not receive midostaurin a twofold lower risk of death (p=0.02) in midostaurin-treated patients. Side effects revealed were acceptable and manageable (mostly digestive). Midostaurin appears to be an effective and safe treatment of AdSM. However, its effect on the course of the AHNMD is less clear. For the future, combined therapy (hypomethylating agents, cladribine, mammalian target of rapamycin inhibitors, chemotherapy, and allogeneic bone marrow transplantation) may further improve long-term survival, particularly that of MCL and AdSM patients with AHNMD.
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Affiliation(s)
- Marie Olivia Chandesris
- French Reference Center for Mastocytosis (CEREMAST), .,Department of Hematology, Necker Children's Hospital, APHP, .,Sorbonne Paris Cité, Paris Descartes University, Imagine Institute, Paris,
| | - Gandhi Damaj
- French Reference Center for Mastocytosis (CEREMAST), .,Department of Hematology, University Hospital, University of Basse Normandy, School of Medicine, Caen
| | - Olivier Lortholary
- French Reference Center for Mastocytosis (CEREMAST), .,Sorbonne Paris Cité, Paris Descartes University, Imagine Institute, Paris, .,Infectious Diseases Department, Necker Children's Hospital, APHP
| | - Olivier Hermine
- French Reference Center for Mastocytosis (CEREMAST), .,Department of Hematology, Necker Children's Hospital, APHP, .,Sorbonne Paris Cité, Paris Descartes University, Imagine Institute, Paris, .,INSERM U1163 and CNRS ERL 8654, Imagine Institute, Paris, France,
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23
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Valent P, Akin C, Hartmann K, Nilsson G, Reiter A, Hermine O, Sotlar K, Sperr WR, Escribano L, George TI, Kluin-Nelemans HC, Ustun C, Triggiani M, Brockow K, Gotlib J, Orfao A, Schwartz LB, Broesby-Olsen S, Bindslev-Jensen C, Kovanen PT, Galli SJ, Austen KF, Arber DA, Horny HP, Arock M, Metcalfe DD. Advances in the Classification and Treatment of Mastocytosis: Current Status and Outlook toward the Future. Cancer Res 2017; 77:1261-1270. [PMID: 28254862 DOI: 10.1158/0008-5472.can-16-2234] [Citation(s) in RCA: 153] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 11/26/2016] [Accepted: 11/28/2016] [Indexed: 02/07/2023]
Abstract
Mastocytosis is a term used to denote a heterogeneous group of conditions defined by the expansion and accumulation of clonal (neoplastic) tissue mast cells in various organs. The classification of the World Health Organization (WHO) divides the disease into cutaneous mastocytosis, systemic mastocytosis, and localized mast cell tumors. On the basis of histomorphologic criteria, clinical parameters, and organ involvement, systemic mastocytosis is further divided into indolent systemic mastocytosis and advanced systemic mastocytosis variants, including aggressive systemic mastocytosis and mast cell leukemia. The clinical impact and prognostic value of this classification has been confirmed in numerous studies, and its basic concept remains valid. However, refinements have recently been proposed by the consensus group, the WHO, and the European Competence Network on Mastocytosis. In addition, new treatment options are available for patients with advanced systemic mastocytosis, including allogeneic hematopoietic stem cell transplantation and multikinase inhibitors directed against KIT D816V and other key signaling molecules. Our current article provides an overview of recent advances in the field of mastocytosis, with emphasis on classification, prognostication, and emerging new treatment options in advanced systemic mastocytosis. Cancer Res; 77(6); 1261-70. ©2017 AACR.
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Affiliation(s)
- Peter Valent
- Department of Medicine I, Division of Hematology and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria.
| | - Cem Akin
- Division of Allergy and Immunology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Karin Hartmann
- Department of Dermatology, University of Luebeck, Luebeck, Germany
| | - Gunnar Nilsson
- Department of Medicine Solna & Mastocytosis Centre, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Andreas Reiter
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Olivier Hermine
- Imagine Institute Université Paris Descartes, Sorbonne, Paris Cité, Centre National de Référence des Mastocytoses, Paris, France
| | - Karl Sotlar
- Institute of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Wolfgang R Sperr
- Department of Medicine I, Division of Hematology and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria
| | - Luis Escribano
- Servicio Central de Citometria, Centro de Investigacion del Cancer (IBMCC; CSIC/USAL) Instituto Biosanitario de Salamanca (IBSAL) and Department of Medicine, University of Salamanca, Salamanca, Spain
| | - Tracy I George
- Department of Pathology, University of New Mexico, Albuquerque, New Mexico
| | - Hanneke C Kluin-Nelemans
- Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Celalettin Ustun
- Division of Hematology-Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Massimo Triggiani
- Division of Allergy and Clinical Immunology, University of Salerno, Salerno, Italy
| | - Knut Brockow
- Department of Dermatology and Allergy Biederstein, Technical University of Munich, Munich, Germany
| | - Jason Gotlib
- Division of Hematology, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California
| | - Alberto Orfao
- Servicio Central de Citometria, Centro de Investigacion del Cancer (IBMCC; CSIC/USAL) Instituto Biosanitario de Salamanca (IBSAL) and Department of Medicine, University of Salamanca, Salamanca, Spain
| | - Lawrence B Schwartz
- Department of Internal Medicine, Division of Rheumatology, Allergy & Immunology, Virginia Commonwealth University, Richmond, Virginia
| | - Sigurd Broesby-Olsen
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark
| | | | | | - Stephen J Galli
- Institute of Pathology, University of Chicago, Chicago, Illinois
| | - K Frank Austen
- Division of Allergy and Immunology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Daniel A Arber
- Institute of Pathology, University of Chicago, Chicago, Illinois
| | - Hans-Peter Horny
- Institute of Pathology, Ludwig-Maximilians-University, Munich, Germany
| | - Michel Arock
- LBPA CNRS UMR8113, Ecole Normale Supérieure de Cachan, Cachan, France
| | - Dean D Metcalfe
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland
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24
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Systemic Mastocytosis Causing Refractory Pruritus in a Liver Disease Patient. ACG Case Rep J 2016; 3:e152. [PMID: 27921051 PMCID: PMC5126489 DOI: 10.14309/crj.2016.125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 04/15/2016] [Indexed: 01/08/2023] Open
Abstract
Systemic mastocytosis (SM) results from clonal, neoplastic proliferation of abnormal mast cells. Patients become susceptible to itching, urticaria, and anaphylactic shock, which occurs due to histamine release from mast cells. SM may coexist alongside other systemic diseases, thus confounding the overall clinical presentation. We discuss a 23-year-old woman with refractory pruritus, which was initially attributed to primary sclerosing cholangitis but had a nonresponse to antihistaminics, ursodiol, and cholestyramine. Concurrent evaluation for polyarthritis revealed increased uptake in the proximal femur on a bone scan, and subsequent bone marrow biopsy revealed indolent SM, and this was understood to be the cause of her intractable pruritus.
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25
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González-de-Olano D, Matito A, Orfao A, Escribano L. Advances in the understanding and clinical management of mastocytosis and clonal mast cell activation syndromes. F1000Res 2016; 5:2666. [PMID: 27909577 PMCID: PMC5112577 DOI: 10.12688/f1000research.9565.1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/07/2016] [Indexed: 01/10/2023] Open
Abstract
Clonal mast cell activation syndromes and indolent systemic mastocytosis without skin involvement are two emerging entities that sometimes might be clinically difficult to distinguish, and they involve a great challenge for the physician from both a diagnostic and a therapeutic point of view. Furthermore, final diagnosis of both entities requires a bone marrow study; it is recommended that this be done in reference centers. In this article, we address the current consensus and guidelines for the suspicion, diagnosis, classification, treatment, and management of these two entities.
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Affiliation(s)
| | - Almudena Matito
- Instituto de Estudios de Mastocitosis de Castilla La Mancha (CLMast), Hospital Virgen del Valle, Toledo, 45071, Spain
| | - Alberto Orfao
- Centro de Investigación del Cáncer/IBMCC (CSIC/USAL), Departamento de Medicina, IBSAL and Servicio General de Citometría, University of Salamanca, Salamanca, 37007, Spain
| | - Luis Escribano
- Centro de Investigación del Cáncer/IBMCC (CSIC/USAL), Departamento de Medicina, IBSAL and Servicio General de Citometría, University of Salamanca, Salamanca, 37007, Spain
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Pardanani A. Systemic mastocytosis in adults: 2017 update on diagnosis, risk stratification and management. Am J Hematol 2016; 91:1146-1159. [PMID: 27762455 DOI: 10.1002/ajh.24553] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 09/12/2016] [Indexed: 12/17/2022]
Abstract
Disease overview:Systemic mastocytosis (SM) results from a clonal proliferation of abnormal mast cells (MC) in one or more extra-cutaneous organs. DIAGNOSIS The major criterion is presence of multifocal clusters of morphologically abnormal MC in the bone marrow. Minor diagnostic criteria include elevated serum tryptase level, abnormal MC expression of CD25 and/or CD2, and presence of KITD816V. Risk stratification: The 2008 World Health Organization (WHO) classification of SM has been shown to be prognostically relevant. Classification of SM patients into indolent (SM), aggressive SM (ASM), SM associated with a clonal non-MC lineage disease (SM-AHNMD) and mast cell leukemia (MCL) subgroups is a useful first step in establishing prognosis. MANAGEMENT SM treatment is generally palliative. ISM patients have a normal life expectancy and receive symptom-directed therapy; infrequently, cytoreductive therapy may be indicated for refractory symptoms. ASM patients have disease-related organ dysfunction; interferon-α (±corticosteroids) can control dermatological, hematological, gastrointestinal, skeletal and mediator-release symptoms, but is hampered by poor tolerability. Similarly, cladribine has broad therapeutic activity, with particular utility when rapid MC debulking is indicated; the main toxicity is myelosuppression. Imatinib has a therapeutic role in the presence of an imatinib-sensitive KIT mutation or in KITD816-unmutated patients. Treatment of SM-AHNMD is governed primarily by the non-MC neoplasm; hydroxyurea has modest utility in this setting; there is a role for allogeneic stem cell transplantation in select cases. Investigational drugs: Recent data confirms midostaurin's significant anti-MC activity in patients with advanced SM. Am. J. Hematol. 91:1147-1159, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Animesh Pardanani
- Division of Hematology Department of Medicine; Mayo Clinic; Rochester Minnesota
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Bauer K, Hadzijusufovic E, Cerny-Reiterer S, Hoermann G, Reifinger M, Pirker A, Valent P, Willmann M. IL-4 downregulates expression of the target receptor CD30 in neoplastic canine mast cells. Vet Comp Oncol 2016; 15:1240-1256. [PMID: 27507155 DOI: 10.1111/vco.12260] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 05/24/2016] [Accepted: 07/11/2016] [Indexed: 12/15/2022]
Abstract
CD30 is a novel therapeutic target in human mast cell (MC) neoplasms. In this 'comparative oncology' study, we examined CD30 expression and regulation in neoplastic canine MC using a panel of immunomodulatory cytokines [interleukin-2 (IL-2), IL-4, IL-5, IL-6, IL-13 and stem cell factor (SCF)] and the canine mastocytoma cell lines NI-1 and C2. Of all cytokines tested IL-4 was found to downregulate expression of CD30 in NI-1 and C2 cells. We also found that the CD30-targeting antibody-conjugate brentuximab vedotin induces growth inhibition and apoptosis in both MC lines. Next, we asked whether IL-4-induced downregulation of CD30 interferes with brentuximab vedotin-effects. Indeed, pre-incubation of NI-1 cells with IL-4 decreased responsiveness towards brentuximab vedotin. To overcome IL-4-mediated resistance, we applied drug combinations and found that brentuximab vedotin synergizes with the Kit-targeting drugs masitinib and PKC412 in inhibiting growth of NI-1 and C2 cells. In summary, CD30 is a new marker and IL-4-regulated target in neoplastic canine MC.
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Affiliation(s)
- K Bauer
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - E Hadzijusufovic
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria.,Department/Clinic for Companion Animals and Horses, Clinic for Small Animals, Clinical Unit of Internal Medicine, University of Veterinary Medicine Vienna, Vienna, Austria
| | - S Cerny-Reiterer
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria
| | - G Hoermann
- Department for Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - M Reifinger
- Department of Pathobiology, University of Veterinary Medicine Vienna, Vienna, Austria
| | - A Pirker
- Department/Clinic for Companion Animals and Horses, Clinic for Small Animals, Clinical Unit of Surgery, University of Veterinary Medicine Vienna, Vienna, Austria
| | - P Valent
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria
| | - M Willmann
- Department/Clinic for Companion Animals and Horses, Clinic for Small Animals, Clinical Unit of Internal Medicine, University of Veterinary Medicine Vienna, Vienna, Austria
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Alvarez-Twose I, Matito A, Morgado JM, Sánchez-Muñoz L, Jara-Acevedo M, García-Montero A, Mayado A, Caldas C, Teodósio C, Muñoz-González JI, Mollejo M, Escribano L, Orfao A. Imatinib in systemic mastocytosis: a phase IV clinical trial in patients lacking exon 17 KIT mutations and review of the literature. Oncotarget 2016; 8:68950-68963. [PMID: 28978170 PMCID: PMC5620310 DOI: 10.18632/oncotarget.10711] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 05/29/2016] [Indexed: 12/15/2022] Open
Abstract
Resistance to imatinib has been recurrently reported in systemic mastocytosis (SM) carrying exon 17 KIT mutations. We evaluated the efficacy and safety of imatinib therapy in 10 adult SM patients lacking exon 17 KIT mutations, 9 of which fulfilled criteria for well-differentiated SM (WDSM). The World Health Organization 2008 disease categories among WDSM patients were mast cell (MC) leukemia (n = 3), indolent SM (n = 3) and cutaneous mastocytosis (n = 3); the remainder case had SM associated with a clonal haematological non-MC disease. Patients were given imatinib for 12 months -400 or 300 mg daily depending on the presence vs. absence of > 30% bone marrow (BM) MCs and/or signs of advanced disease-. Absence of exon 17 KIT mutations was confirmed in highly-purified BM MCs by peptide nucleic acid-mediated PCR, while mutations involving other exons were investigated by direct sequencing of purified BM MC DNA. Complete response (CR) was defined as resolution of BM MC infiltration, skin lesions, organomegalies and MC-mediator release-associated symptoms, plus normalization of serum tryptase. Criteria for partial response (PR) included ≥ 50% reduction in BM MC infiltration and improvement of skin lesions and/or organomegalies. Treatment was well-tolerated with an overall response rate of 50%, including early and sustained CR in four patients, three of whom had extracellular mutations of KIT, and PR in one case. This later patient and all non-responders (n = 5) showed wild-type KIT. These results together with previous data from the literature support the relevance of the KIT mutational status in selecting SM patients who are candidates for imatinib therapy.
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Affiliation(s)
- Iván Alvarez-Twose
- Instituto de Estudios de Mastocitosis de Castilla La Mancha (CLMast), Hospital Virgen del Valle, Toledo, Spain.,Spanish Network on Mastocytosis (REMA), Toledo and Salamanca, Spain
| | - Almudena Matito
- Instituto de Estudios de Mastocitosis de Castilla La Mancha (CLMast), Hospital Virgen del Valle, Toledo, Spain.,Spanish Network on Mastocytosis (REMA), Toledo and Salamanca, Spain
| | - José Mário Morgado
- Instituto de Estudios de Mastocitosis de Castilla La Mancha (CLMast), Hospital Virgen del Valle, Toledo, Spain.,Spanish Network on Mastocytosis (REMA), Toledo and Salamanca, Spain
| | - Laura Sánchez-Muñoz
- Instituto de Estudios de Mastocitosis de Castilla La Mancha (CLMast), Hospital Virgen del Valle, Toledo, Spain.,Spanish Network on Mastocytosis (REMA), Toledo and Salamanca, Spain
| | - María Jara-Acevedo
- Centro de Investigación del Cáncer/IBMCC (USAL/CSIC) and IBSAL, Departamento de Medicina and Servicio General de Citometría, University of Salamanca, Salamanca, Spain.,Spanish Network on Mastocytosis (REMA), Toledo and Salamanca, Spain
| | - Andrés García-Montero
- Centro de Investigación del Cáncer/IBMCC (USAL/CSIC) and IBSAL, Departamento de Medicina and Servicio General de Citometría, University of Salamanca, Salamanca, Spain.,Spanish Network on Mastocytosis (REMA), Toledo and Salamanca, Spain
| | - Andrea Mayado
- Centro de Investigación del Cáncer/IBMCC (USAL/CSIC) and IBSAL, Departamento de Medicina and Servicio General de Citometría, University of Salamanca, Salamanca, Spain.,Spanish Network on Mastocytosis (REMA), Toledo and Salamanca, Spain
| | - Carolina Caldas
- Centro de Investigación del Cáncer/IBMCC (USAL/CSIC) and IBSAL, Departamento de Medicina and Servicio General de Citometría, University of Salamanca, Salamanca, Spain.,Spanish Network on Mastocytosis (REMA), Toledo and Salamanca, Spain
| | - Cristina Teodósio
- Department of Immunology, Erasmus Medical Center, University of Rotterdam, Rotterdam, The Netherlands
| | - Javier Ignacio Muñoz-González
- Centro de Investigación del Cáncer/IBMCC (USAL/CSIC) and IBSAL, Departamento de Medicina and Servicio General de Citometría, University of Salamanca, Salamanca, Spain.,Spanish Network on Mastocytosis (REMA), Toledo and Salamanca, Spain
| | - Manuela Mollejo
- Department of Pathology, Hospital Virgen de la Salud, Toledo, Spain.,Spanish Network on Mastocytosis (REMA), Toledo and Salamanca, Spain
| | - Luis Escribano
- Centro de Investigación del Cáncer/IBMCC (USAL/CSIC) and IBSAL, Departamento de Medicina and Servicio General de Citometría, University of Salamanca, Salamanca, Spain.,Spanish Network on Mastocytosis (REMA), Toledo and Salamanca, Spain
| | - Alberto Orfao
- Centro de Investigación del Cáncer/IBMCC (USAL/CSIC) and IBSAL, Departamento de Medicina and Servicio General de Citometría, University of Salamanca, Salamanca, Spain.,Spanish Network on Mastocytosis (REMA), Toledo and Salamanca, Spain
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29
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Splenomegaly, elevated alkaline phosphatase and mutations in the SRSF2/ASXL1/RUNX1 gene panel are strong adverse prognostic markers in patients with systemic mastocytosis. Leukemia 2016; 30:2342-2350. [PMID: 27416984 DOI: 10.1038/leu.2016.190] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 06/06/2016] [Accepted: 06/10/2016] [Indexed: 01/08/2023]
Abstract
We evaluated the impact of clinical and molecular characteristics on overall survival (OS) in 108 patients with indolent (n=41) and advanced systemic mastocytosis (SM) (advSM, n=67). Organomegaly was measured by magnetic resonance imaging-based volumetry of the liver and spleen. In multivariate analysis of all patients, an increased spleen volume ⩾450 ml (hazard ratio (HR), 5.2; 95% confidence interval (CI), (2.1-13.0); P=0.003) and an elevated alkaline phosphatase (AP; HR 5.0 (1.1-22.2); P=0.02) were associated with adverse OS. The 3-year OS was 100, 77, and 39%, respectively (P<0.0001), for patients with 0 (low risk, n=37), 1 (intermediate risk, n=32) or 2 (high risk, n=39) parameters. For advSM patients with fully available clinical and molecular data (n=60), univariate analysis identified splenomegaly ⩾1200 ml, elevated AP and mutations in the SRSF2/ASXL1/RUNX1 (S/A/R) gene panel as significant prognostic markers. In multivariate analysis, mutations in S/A/R (HR 3.2 (1.1-9.6); P=0.01) and elevated AP (HR 2.6 (1.0-7.1); P=0.03) remained predictive adverse prognostic markers for OS. The 3-year OS was 76 and 38%, respectively (P=0.0003), for patients with 0-1 (intermediate risk, n=28) or 2 (high risk, n=32) parameters. We conclude that splenomegaly, elevated AP and mutations in the S/A/R gene panel are independent of the World Health Organization classification and provide the most relevant prognostic information in SM patients.
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30
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Ravichandran S, Chitrapur RG, Bhave S, Chakrapani A, Nair R, Chandy M. Systemic Mastocytosis with Associated Clonal Hematological Non-Mast Cell Lineage Disorder (MDS-RCMD): A Difficult Disease to Diagnose and Treat. Indian J Hematol Blood Transfus 2016; 32:108-11. [PMID: 27408369 DOI: 10.1007/s12288-015-0594-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 09/04/2015] [Indexed: 11/28/2022] Open
Abstract
Systemic mastocytosis is a rare and recalcitrant disorder with nonspecific clinical features. Hence, a high index of suspicion is required. Here, we report the case of a 64 years old male presenting with chronic diarrhoea that was evaluated at different centres and treated with multiple lines of therapy. The diagnosis of aggressive systemic mastocytosis was finally clinched following a holistic work up that included a Jejunal biopsy and a laparoscopic lymph node biopsy. Treatment of this disorder is difficult, responses are transient and most patients will eventually relapse, as illustrated by this case. Cladribine, Interferon α, steroids and imatinib have limited success in the management of this disease. The role of stem cell transplant is uncertain.
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Affiliation(s)
- Sriram Ravichandran
- Department of Clinical Haematology, Tata Medical Center, Kolkata, 700156 India
| | - Rohith G Chitrapur
- Department of Clinical Haematology, Tata Medical Center, Kolkata, 700156 India
| | - Saurabh Bhave
- Department of Clinical Haematology, Tata Medical Center, Kolkata, 700156 India
| | - Anupam Chakrapani
- Department of Clinical Haematology, Tata Medical Center, Kolkata, 700156 India
| | - Reena Nair
- Department of Clinical Haematology, Tata Medical Center, Kolkata, 700156 India
| | - Mammen Chandy
- Department of Clinical Haematology, Tata Medical Center, Kolkata, 700156 India
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31
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Gotlib J, Kluin-Nelemans HC, George TI, Akin C, Sotlar K, Hermine O, Awan FT, Hexner E, Mauro MJ, Sternberg DW, Villeneuve M, Huntsman Labed A, Stanek EJ, Hartmann K, Horny HP, Valent P, Reiter A. Efficacy and Safety of Midostaurin in Advanced Systemic Mastocytosis. N Engl J Med 2016; 374:2530-41. [PMID: 27355533 DOI: 10.1056/nejmoa1513098] [Citation(s) in RCA: 315] [Impact Index Per Article: 39.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Advanced systemic mastocytosis comprises rare hematologic neoplasms that are associated with a poor prognosis and lack effective treatment options. The multikinase inhibitor midostaurin inhibits KIT D816V, a primary driver of disease pathogenesis. METHODS We conducted an open-label study of oral midostaurin at a dose of 100 mg twice daily in 116 patients, of whom 89 with mastocytosis-related organ damage were eligible for inclusion in the primary efficacy population; 16 had aggressive systemic mastocytosis, 57 had systemic mastocytosis with an associated hematologic neoplasm, and 16 had mast-cell leukemia. The primary outcome was the best overall response. RESULTS The overall response rate was 60% (95% confidence interval [CI], 49 to 70); 45% of the patients had a major response, which was defined as complete resolution of at least one type of mastocytosis-related organ damage. Response rates were similar regardless of the subtype of advanced systemic mastocytosis, KIT mutation status, or exposure to previous therapy. The median best percentage changes in bone marrow mast-cell burden and serum tryptase level were -59% and -58%, respectively. The median overall survival was 28.7 months, and the median progression-free survival was 14.1 months. Among the 16 patients with mast-cell leukemia, the median overall survival was 9.4 months (95% CI, 7.5 to not estimated). Dose reduction owing to toxic effects occurred in 56% of the patients; re-escalation to the starting dose was feasible in 32% of those patients. The most frequent adverse events were low-grade nausea, vomiting, and diarrhea. New or worsening grade 3 or 4 neutropenia, anemia, and thrombocytopenia occurred in 24%, 41%, and 29% of the patients, respectively, mostly in those with preexisting cytopenias. CONCLUSIONS In this open-label study, midostaurin showed efficacy in patients with advanced systemic mastocytosis, including the highly fatal variant mast-cell leukemia. (Funded by Novartis Pharmaceuticals and others; ClinicalTrials.gov number, NCT00782067.).
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Affiliation(s)
- Jason Gotlib
- From the Hematology Division, Stanford University School of Medicine-Stanford Cancer Institute, Stanford, CA (J.G.); Faculty of Medical Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (H.C.K.-N.); Department of Pathology, University of New Mexico, Albuquerque (T.I.G.); Mastocytosis Center, Brigham and Women's Hospital, Boston (C.A.); Institute of Pathology, Ludwig-Maximilians-University Munich, Munich (K.S., H.-P.H.), Department of Dermatology and Venereology, University of Cologne, Cologne, and University of Luebeck, Luebeck (K.H.), and Department of Hematology and Oncology, University Hospital Mannheim of the University of Heidelberg, Mannheim (A.R.) - all in Germany; University of Paris Descartes, Institut Imagine INSERM Unité 1163 and Centre National de la Recherche Scientifique ERL8654, Centre de Reference des Mastocytoses, Paris (O.H.); Division of Hematology, Department of Internal Medicine, Ohio State University Comprehensive Cancer Center, Columbus (F.T.A.); Division of Hematology/Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia (E.H.); Myeloproliferative Neoplasms Program, Memorial Sloan Kettering Cancer Center, New York (M.J.M.); Novartis Pharmaceuticals, East Hanover, NJ (D.W.S., E.J.S.); Novartis Pharma, Basel, Switzerland (M.V., A.H.L.); and the Department of Internal Medicine I, Division of Hematology and Hemostaseology, and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna (P.V.)
| | - Hanneke C Kluin-Nelemans
- From the Hematology Division, Stanford University School of Medicine-Stanford Cancer Institute, Stanford, CA (J.G.); Faculty of Medical Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (H.C.K.-N.); Department of Pathology, University of New Mexico, Albuquerque (T.I.G.); Mastocytosis Center, Brigham and Women's Hospital, Boston (C.A.); Institute of Pathology, Ludwig-Maximilians-University Munich, Munich (K.S., H.-P.H.), Department of Dermatology and Venereology, University of Cologne, Cologne, and University of Luebeck, Luebeck (K.H.), and Department of Hematology and Oncology, University Hospital Mannheim of the University of Heidelberg, Mannheim (A.R.) - all in Germany; University of Paris Descartes, Institut Imagine INSERM Unité 1163 and Centre National de la Recherche Scientifique ERL8654, Centre de Reference des Mastocytoses, Paris (O.H.); Division of Hematology, Department of Internal Medicine, Ohio State University Comprehensive Cancer Center, Columbus (F.T.A.); Division of Hematology/Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia (E.H.); Myeloproliferative Neoplasms Program, Memorial Sloan Kettering Cancer Center, New York (M.J.M.); Novartis Pharmaceuticals, East Hanover, NJ (D.W.S., E.J.S.); Novartis Pharma, Basel, Switzerland (M.V., A.H.L.); and the Department of Internal Medicine I, Division of Hematology and Hemostaseology, and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna (P.V.)
| | - Tracy I George
- From the Hematology Division, Stanford University School of Medicine-Stanford Cancer Institute, Stanford, CA (J.G.); Faculty of Medical Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (H.C.K.-N.); Department of Pathology, University of New Mexico, Albuquerque (T.I.G.); Mastocytosis Center, Brigham and Women's Hospital, Boston (C.A.); Institute of Pathology, Ludwig-Maximilians-University Munich, Munich (K.S., H.-P.H.), Department of Dermatology and Venereology, University of Cologne, Cologne, and University of Luebeck, Luebeck (K.H.), and Department of Hematology and Oncology, University Hospital Mannheim of the University of Heidelberg, Mannheim (A.R.) - all in Germany; University of Paris Descartes, Institut Imagine INSERM Unité 1163 and Centre National de la Recherche Scientifique ERL8654, Centre de Reference des Mastocytoses, Paris (O.H.); Division of Hematology, Department of Internal Medicine, Ohio State University Comprehensive Cancer Center, Columbus (F.T.A.); Division of Hematology/Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia (E.H.); Myeloproliferative Neoplasms Program, Memorial Sloan Kettering Cancer Center, New York (M.J.M.); Novartis Pharmaceuticals, East Hanover, NJ (D.W.S., E.J.S.); Novartis Pharma, Basel, Switzerland (M.V., A.H.L.); and the Department of Internal Medicine I, Division of Hematology and Hemostaseology, and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna (P.V.)
| | - Cem Akin
- From the Hematology Division, Stanford University School of Medicine-Stanford Cancer Institute, Stanford, CA (J.G.); Faculty of Medical Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (H.C.K.-N.); Department of Pathology, University of New Mexico, Albuquerque (T.I.G.); Mastocytosis Center, Brigham and Women's Hospital, Boston (C.A.); Institute of Pathology, Ludwig-Maximilians-University Munich, Munich (K.S., H.-P.H.), Department of Dermatology and Venereology, University of Cologne, Cologne, and University of Luebeck, Luebeck (K.H.), and Department of Hematology and Oncology, University Hospital Mannheim of the University of Heidelberg, Mannheim (A.R.) - all in Germany; University of Paris Descartes, Institut Imagine INSERM Unité 1163 and Centre National de la Recherche Scientifique ERL8654, Centre de Reference des Mastocytoses, Paris (O.H.); Division of Hematology, Department of Internal Medicine, Ohio State University Comprehensive Cancer Center, Columbus (F.T.A.); Division of Hematology/Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia (E.H.); Myeloproliferative Neoplasms Program, Memorial Sloan Kettering Cancer Center, New York (M.J.M.); Novartis Pharmaceuticals, East Hanover, NJ (D.W.S., E.J.S.); Novartis Pharma, Basel, Switzerland (M.V., A.H.L.); and the Department of Internal Medicine I, Division of Hematology and Hemostaseology, and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna (P.V.)
| | - Karl Sotlar
- From the Hematology Division, Stanford University School of Medicine-Stanford Cancer Institute, Stanford, CA (J.G.); Faculty of Medical Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (H.C.K.-N.); Department of Pathology, University of New Mexico, Albuquerque (T.I.G.); Mastocytosis Center, Brigham and Women's Hospital, Boston (C.A.); Institute of Pathology, Ludwig-Maximilians-University Munich, Munich (K.S., H.-P.H.), Department of Dermatology and Venereology, University of Cologne, Cologne, and University of Luebeck, Luebeck (K.H.), and Department of Hematology and Oncology, University Hospital Mannheim of the University of Heidelberg, Mannheim (A.R.) - all in Germany; University of Paris Descartes, Institut Imagine INSERM Unité 1163 and Centre National de la Recherche Scientifique ERL8654, Centre de Reference des Mastocytoses, Paris (O.H.); Division of Hematology, Department of Internal Medicine, Ohio State University Comprehensive Cancer Center, Columbus (F.T.A.); Division of Hematology/Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia (E.H.); Myeloproliferative Neoplasms Program, Memorial Sloan Kettering Cancer Center, New York (M.J.M.); Novartis Pharmaceuticals, East Hanover, NJ (D.W.S., E.J.S.); Novartis Pharma, Basel, Switzerland (M.V., A.H.L.); and the Department of Internal Medicine I, Division of Hematology and Hemostaseology, and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna (P.V.)
| | - Olivier Hermine
- From the Hematology Division, Stanford University School of Medicine-Stanford Cancer Institute, Stanford, CA (J.G.); Faculty of Medical Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (H.C.K.-N.); Department of Pathology, University of New Mexico, Albuquerque (T.I.G.); Mastocytosis Center, Brigham and Women's Hospital, Boston (C.A.); Institute of Pathology, Ludwig-Maximilians-University Munich, Munich (K.S., H.-P.H.), Department of Dermatology and Venereology, University of Cologne, Cologne, and University of Luebeck, Luebeck (K.H.), and Department of Hematology and Oncology, University Hospital Mannheim of the University of Heidelberg, Mannheim (A.R.) - all in Germany; University of Paris Descartes, Institut Imagine INSERM Unité 1163 and Centre National de la Recherche Scientifique ERL8654, Centre de Reference des Mastocytoses, Paris (O.H.); Division of Hematology, Department of Internal Medicine, Ohio State University Comprehensive Cancer Center, Columbus (F.T.A.); Division of Hematology/Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia (E.H.); Myeloproliferative Neoplasms Program, Memorial Sloan Kettering Cancer Center, New York (M.J.M.); Novartis Pharmaceuticals, East Hanover, NJ (D.W.S., E.J.S.); Novartis Pharma, Basel, Switzerland (M.V., A.H.L.); and the Department of Internal Medicine I, Division of Hematology and Hemostaseology, and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna (P.V.)
| | - Farrukh T Awan
- From the Hematology Division, Stanford University School of Medicine-Stanford Cancer Institute, Stanford, CA (J.G.); Faculty of Medical Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (H.C.K.-N.); Department of Pathology, University of New Mexico, Albuquerque (T.I.G.); Mastocytosis Center, Brigham and Women's Hospital, Boston (C.A.); Institute of Pathology, Ludwig-Maximilians-University Munich, Munich (K.S., H.-P.H.), Department of Dermatology and Venereology, University of Cologne, Cologne, and University of Luebeck, Luebeck (K.H.), and Department of Hematology and Oncology, University Hospital Mannheim of the University of Heidelberg, Mannheim (A.R.) - all in Germany; University of Paris Descartes, Institut Imagine INSERM Unité 1163 and Centre National de la Recherche Scientifique ERL8654, Centre de Reference des Mastocytoses, Paris (O.H.); Division of Hematology, Department of Internal Medicine, Ohio State University Comprehensive Cancer Center, Columbus (F.T.A.); Division of Hematology/Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia (E.H.); Myeloproliferative Neoplasms Program, Memorial Sloan Kettering Cancer Center, New York (M.J.M.); Novartis Pharmaceuticals, East Hanover, NJ (D.W.S., E.J.S.); Novartis Pharma, Basel, Switzerland (M.V., A.H.L.); and the Department of Internal Medicine I, Division of Hematology and Hemostaseology, and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna (P.V.)
| | - Elizabeth Hexner
- From the Hematology Division, Stanford University School of Medicine-Stanford Cancer Institute, Stanford, CA (J.G.); Faculty of Medical Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (H.C.K.-N.); Department of Pathology, University of New Mexico, Albuquerque (T.I.G.); Mastocytosis Center, Brigham and Women's Hospital, Boston (C.A.); Institute of Pathology, Ludwig-Maximilians-University Munich, Munich (K.S., H.-P.H.), Department of Dermatology and Venereology, University of Cologne, Cologne, and University of Luebeck, Luebeck (K.H.), and Department of Hematology and Oncology, University Hospital Mannheim of the University of Heidelberg, Mannheim (A.R.) - all in Germany; University of Paris Descartes, Institut Imagine INSERM Unité 1163 and Centre National de la Recherche Scientifique ERL8654, Centre de Reference des Mastocytoses, Paris (O.H.); Division of Hematology, Department of Internal Medicine, Ohio State University Comprehensive Cancer Center, Columbus (F.T.A.); Division of Hematology/Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia (E.H.); Myeloproliferative Neoplasms Program, Memorial Sloan Kettering Cancer Center, New York (M.J.M.); Novartis Pharmaceuticals, East Hanover, NJ (D.W.S., E.J.S.); Novartis Pharma, Basel, Switzerland (M.V., A.H.L.); and the Department of Internal Medicine I, Division of Hematology and Hemostaseology, and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna (P.V.)
| | - Michael J Mauro
- From the Hematology Division, Stanford University School of Medicine-Stanford Cancer Institute, Stanford, CA (J.G.); Faculty of Medical Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (H.C.K.-N.); Department of Pathology, University of New Mexico, Albuquerque (T.I.G.); Mastocytosis Center, Brigham and Women's Hospital, Boston (C.A.); Institute of Pathology, Ludwig-Maximilians-University Munich, Munich (K.S., H.-P.H.), Department of Dermatology and Venereology, University of Cologne, Cologne, and University of Luebeck, Luebeck (K.H.), and Department of Hematology and Oncology, University Hospital Mannheim of the University of Heidelberg, Mannheim (A.R.) - all in Germany; University of Paris Descartes, Institut Imagine INSERM Unité 1163 and Centre National de la Recherche Scientifique ERL8654, Centre de Reference des Mastocytoses, Paris (O.H.); Division of Hematology, Department of Internal Medicine, Ohio State University Comprehensive Cancer Center, Columbus (F.T.A.); Division of Hematology/Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia (E.H.); Myeloproliferative Neoplasms Program, Memorial Sloan Kettering Cancer Center, New York (M.J.M.); Novartis Pharmaceuticals, East Hanover, NJ (D.W.S., E.J.S.); Novartis Pharma, Basel, Switzerland (M.V., A.H.L.); and the Department of Internal Medicine I, Division of Hematology and Hemostaseology, and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna (P.V.)
| | - David W Sternberg
- From the Hematology Division, Stanford University School of Medicine-Stanford Cancer Institute, Stanford, CA (J.G.); Faculty of Medical Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (H.C.K.-N.); Department of Pathology, University of New Mexico, Albuquerque (T.I.G.); Mastocytosis Center, Brigham and Women's Hospital, Boston (C.A.); Institute of Pathology, Ludwig-Maximilians-University Munich, Munich (K.S., H.-P.H.), Department of Dermatology and Venereology, University of Cologne, Cologne, and University of Luebeck, Luebeck (K.H.), and Department of Hematology and Oncology, University Hospital Mannheim of the University of Heidelberg, Mannheim (A.R.) - all in Germany; University of Paris Descartes, Institut Imagine INSERM Unité 1163 and Centre National de la Recherche Scientifique ERL8654, Centre de Reference des Mastocytoses, Paris (O.H.); Division of Hematology, Department of Internal Medicine, Ohio State University Comprehensive Cancer Center, Columbus (F.T.A.); Division of Hematology/Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia (E.H.); Myeloproliferative Neoplasms Program, Memorial Sloan Kettering Cancer Center, New York (M.J.M.); Novartis Pharmaceuticals, East Hanover, NJ (D.W.S., E.J.S.); Novartis Pharma, Basel, Switzerland (M.V., A.H.L.); and the Department of Internal Medicine I, Division of Hematology and Hemostaseology, and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna (P.V.)
| | - Matthieu Villeneuve
- From the Hematology Division, Stanford University School of Medicine-Stanford Cancer Institute, Stanford, CA (J.G.); Faculty of Medical Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (H.C.K.-N.); Department of Pathology, University of New Mexico, Albuquerque (T.I.G.); Mastocytosis Center, Brigham and Women's Hospital, Boston (C.A.); Institute of Pathology, Ludwig-Maximilians-University Munich, Munich (K.S., H.-P.H.), Department of Dermatology and Venereology, University of Cologne, Cologne, and University of Luebeck, Luebeck (K.H.), and Department of Hematology and Oncology, University Hospital Mannheim of the University of Heidelberg, Mannheim (A.R.) - all in Germany; University of Paris Descartes, Institut Imagine INSERM Unité 1163 and Centre National de la Recherche Scientifique ERL8654, Centre de Reference des Mastocytoses, Paris (O.H.); Division of Hematology, Department of Internal Medicine, Ohio State University Comprehensive Cancer Center, Columbus (F.T.A.); Division of Hematology/Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia (E.H.); Myeloproliferative Neoplasms Program, Memorial Sloan Kettering Cancer Center, New York (M.J.M.); Novartis Pharmaceuticals, East Hanover, NJ (D.W.S., E.J.S.); Novartis Pharma, Basel, Switzerland (M.V., A.H.L.); and the Department of Internal Medicine I, Division of Hematology and Hemostaseology, and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna (P.V.)
| | - Alice Huntsman Labed
- From the Hematology Division, Stanford University School of Medicine-Stanford Cancer Institute, Stanford, CA (J.G.); Faculty of Medical Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (H.C.K.-N.); Department of Pathology, University of New Mexico, Albuquerque (T.I.G.); Mastocytosis Center, Brigham and Women's Hospital, Boston (C.A.); Institute of Pathology, Ludwig-Maximilians-University Munich, Munich (K.S., H.-P.H.), Department of Dermatology and Venereology, University of Cologne, Cologne, and University of Luebeck, Luebeck (K.H.), and Department of Hematology and Oncology, University Hospital Mannheim of the University of Heidelberg, Mannheim (A.R.) - all in Germany; University of Paris Descartes, Institut Imagine INSERM Unité 1163 and Centre National de la Recherche Scientifique ERL8654, Centre de Reference des Mastocytoses, Paris (O.H.); Division of Hematology, Department of Internal Medicine, Ohio State University Comprehensive Cancer Center, Columbus (F.T.A.); Division of Hematology/Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia (E.H.); Myeloproliferative Neoplasms Program, Memorial Sloan Kettering Cancer Center, New York (M.J.M.); Novartis Pharmaceuticals, East Hanover, NJ (D.W.S., E.J.S.); Novartis Pharma, Basel, Switzerland (M.V., A.H.L.); and the Department of Internal Medicine I, Division of Hematology and Hemostaseology, and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna (P.V.)
| | - Eric J Stanek
- From the Hematology Division, Stanford University School of Medicine-Stanford Cancer Institute, Stanford, CA (J.G.); Faculty of Medical Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (H.C.K.-N.); Department of Pathology, University of New Mexico, Albuquerque (T.I.G.); Mastocytosis Center, Brigham and Women's Hospital, Boston (C.A.); Institute of Pathology, Ludwig-Maximilians-University Munich, Munich (K.S., H.-P.H.), Department of Dermatology and Venereology, University of Cologne, Cologne, and University of Luebeck, Luebeck (K.H.), and Department of Hematology and Oncology, University Hospital Mannheim of the University of Heidelberg, Mannheim (A.R.) - all in Germany; University of Paris Descartes, Institut Imagine INSERM Unité 1163 and Centre National de la Recherche Scientifique ERL8654, Centre de Reference des Mastocytoses, Paris (O.H.); Division of Hematology, Department of Internal Medicine, Ohio State University Comprehensive Cancer Center, Columbus (F.T.A.); Division of Hematology/Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia (E.H.); Myeloproliferative Neoplasms Program, Memorial Sloan Kettering Cancer Center, New York (M.J.M.); Novartis Pharmaceuticals, East Hanover, NJ (D.W.S., E.J.S.); Novartis Pharma, Basel, Switzerland (M.V., A.H.L.); and the Department of Internal Medicine I, Division of Hematology and Hemostaseology, and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna (P.V.)
| | - Karin Hartmann
- From the Hematology Division, Stanford University School of Medicine-Stanford Cancer Institute, Stanford, CA (J.G.); Faculty of Medical Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (H.C.K.-N.); Department of Pathology, University of New Mexico, Albuquerque (T.I.G.); Mastocytosis Center, Brigham and Women's Hospital, Boston (C.A.); Institute of Pathology, Ludwig-Maximilians-University Munich, Munich (K.S., H.-P.H.), Department of Dermatology and Venereology, University of Cologne, Cologne, and University of Luebeck, Luebeck (K.H.), and Department of Hematology and Oncology, University Hospital Mannheim of the University of Heidelberg, Mannheim (A.R.) - all in Germany; University of Paris Descartes, Institut Imagine INSERM Unité 1163 and Centre National de la Recherche Scientifique ERL8654, Centre de Reference des Mastocytoses, Paris (O.H.); Division of Hematology, Department of Internal Medicine, Ohio State University Comprehensive Cancer Center, Columbus (F.T.A.); Division of Hematology/Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia (E.H.); Myeloproliferative Neoplasms Program, Memorial Sloan Kettering Cancer Center, New York (M.J.M.); Novartis Pharmaceuticals, East Hanover, NJ (D.W.S., E.J.S.); Novartis Pharma, Basel, Switzerland (M.V., A.H.L.); and the Department of Internal Medicine I, Division of Hematology and Hemostaseology, and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna (P.V.)
| | - Hans-Peter Horny
- From the Hematology Division, Stanford University School of Medicine-Stanford Cancer Institute, Stanford, CA (J.G.); Faculty of Medical Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (H.C.K.-N.); Department of Pathology, University of New Mexico, Albuquerque (T.I.G.); Mastocytosis Center, Brigham and Women's Hospital, Boston (C.A.); Institute of Pathology, Ludwig-Maximilians-University Munich, Munich (K.S., H.-P.H.), Department of Dermatology and Venereology, University of Cologne, Cologne, and University of Luebeck, Luebeck (K.H.), and Department of Hematology and Oncology, University Hospital Mannheim of the University of Heidelberg, Mannheim (A.R.) - all in Germany; University of Paris Descartes, Institut Imagine INSERM Unité 1163 and Centre National de la Recherche Scientifique ERL8654, Centre de Reference des Mastocytoses, Paris (O.H.); Division of Hematology, Department of Internal Medicine, Ohio State University Comprehensive Cancer Center, Columbus (F.T.A.); Division of Hematology/Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia (E.H.); Myeloproliferative Neoplasms Program, Memorial Sloan Kettering Cancer Center, New York (M.J.M.); Novartis Pharmaceuticals, East Hanover, NJ (D.W.S., E.J.S.); Novartis Pharma, Basel, Switzerland (M.V., A.H.L.); and the Department of Internal Medicine I, Division of Hematology and Hemostaseology, and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna (P.V.)
| | - Peter Valent
- From the Hematology Division, Stanford University School of Medicine-Stanford Cancer Institute, Stanford, CA (J.G.); Faculty of Medical Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (H.C.K.-N.); Department of Pathology, University of New Mexico, Albuquerque (T.I.G.); Mastocytosis Center, Brigham and Women's Hospital, Boston (C.A.); Institute of Pathology, Ludwig-Maximilians-University Munich, Munich (K.S., H.-P.H.), Department of Dermatology and Venereology, University of Cologne, Cologne, and University of Luebeck, Luebeck (K.H.), and Department of Hematology and Oncology, University Hospital Mannheim of the University of Heidelberg, Mannheim (A.R.) - all in Germany; University of Paris Descartes, Institut Imagine INSERM Unité 1163 and Centre National de la Recherche Scientifique ERL8654, Centre de Reference des Mastocytoses, Paris (O.H.); Division of Hematology, Department of Internal Medicine, Ohio State University Comprehensive Cancer Center, Columbus (F.T.A.); Division of Hematology/Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia (E.H.); Myeloproliferative Neoplasms Program, Memorial Sloan Kettering Cancer Center, New York (M.J.M.); Novartis Pharmaceuticals, East Hanover, NJ (D.W.S., E.J.S.); Novartis Pharma, Basel, Switzerland (M.V., A.H.L.); and the Department of Internal Medicine I, Division of Hematology and Hemostaseology, and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna (P.V.)
| | - Andreas Reiter
- From the Hematology Division, Stanford University School of Medicine-Stanford Cancer Institute, Stanford, CA (J.G.); Faculty of Medical Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (H.C.K.-N.); Department of Pathology, University of New Mexico, Albuquerque (T.I.G.); Mastocytosis Center, Brigham and Women's Hospital, Boston (C.A.); Institute of Pathology, Ludwig-Maximilians-University Munich, Munich (K.S., H.-P.H.), Department of Dermatology and Venereology, University of Cologne, Cologne, and University of Luebeck, Luebeck (K.H.), and Department of Hematology and Oncology, University Hospital Mannheim of the University of Heidelberg, Mannheim (A.R.) - all in Germany; University of Paris Descartes, Institut Imagine INSERM Unité 1163 and Centre National de la Recherche Scientifique ERL8654, Centre de Reference des Mastocytoses, Paris (O.H.); Division of Hematology, Department of Internal Medicine, Ohio State University Comprehensive Cancer Center, Columbus (F.T.A.); Division of Hematology/Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia (E.H.); Myeloproliferative Neoplasms Program, Memorial Sloan Kettering Cancer Center, New York (M.J.M.); Novartis Pharmaceuticals, East Hanover, NJ (D.W.S., E.J.S.); Novartis Pharma, Basel, Switzerland (M.V., A.H.L.); and the Department of Internal Medicine I, Division of Hematology and Hemostaseology, and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna (P.V.)
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Borate U, Mehta A, Reddy V, Tsai M, Josephson N, Schnadig I. Treatment of CD30-positive systemic mastocytosis with brentuximab vedotin. Leuk Res 2016; 44:25-31. [DOI: 10.1016/j.leukres.2016.02.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 01/25/2016] [Accepted: 02/25/2016] [Indexed: 12/20/2022]
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Molderings GJ, Haenisch B, Brettner S, Homann J, Menzen M, Dumoulin FL, Panse J, Butterfield J, Afrin LB. Pharmacological treatment options for mast cell activation disease. Naunyn Schmiedebergs Arch Pharmacol 2016; 389:671-94. [PMID: 27132234 PMCID: PMC4903110 DOI: 10.1007/s00210-016-1247-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 04/11/2016] [Indexed: 12/20/2022]
Abstract
Mast cell activation disease (MCAD) is a term referring to a heterogeneous group of disorders characterized by aberrant release of variable subsets of mast cell (MC) mediators together with accumulation of either morphologically altered and immunohistochemically identifiable mutated MCs due to MC proliferation (systemic mastocytosis [SM] and MC leukemia [MCL]) or morphologically ordinary MCs due to decreased apoptosis (MC activation syndrome [MCAS] and well-differentiated SM). Clinical signs and symptoms in MCAD vary depending on disease subtype and result from excessive mediator release by MCs and, in aggressive forms, from organ failure related to MC infiltration. In most cases, treatment of MCAD is directed primarily at controlling the symptoms associated with MC mediator release. In advanced forms, such as aggressive SM and MCL, agents targeting MC proliferation such as kinase inhibitors may be provided. Targeted therapies aimed at blocking mutant protein variants and/or downstream signaling pathways are currently being developed. Other targets, such as specific surface antigens expressed on neoplastic MCs, might be considered for the development of future therapies. Since clinicians are often underprepared to evaluate, diagnose, and effectively treat this clinically heterogeneous disease, we seek to familiarize clinicians with MCAD and review current and future treatment approaches.
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Affiliation(s)
- Gerhard J Molderings
- Institute of Human Genetics, University Hospital of Bonn, Sigmund-Freud-Strasse 25, 53127, Bonn, Germany.
| | - Britta Haenisch
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Stefan Brettner
- Department of Oncology, Hematology and Palliative Care, Kreiskrankenhaus Waldbröl, Waldbröl, Germany
| | - Jürgen Homann
- Allgemeine Innere Medizin, Gastroenterologie und Diabetologie, Gemeinschaftskrankenhaus, Bonn, Germany
| | - Markus Menzen
- Allgemeine Innere Medizin, Gastroenterologie und Diabetologie, Gemeinschaftskrankenhaus, Bonn, Germany
| | - Franz Ludwig Dumoulin
- Allgemeine Innere Medizin, Gastroenterologie und Diabetologie, Gemeinschaftskrankenhaus, Bonn, Germany
| | - Jens Panse
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Joseph Butterfield
- Program for the Study of Mast Cell and Eosinophil Disorders, Mayo Clinic, Rochester, MN, 55905, USA
| | - Lawrence B Afrin
- Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, MN, 55455, USA
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Systemic Mastocytosis: Clinical Update and Future Directions. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2015; 15:728-38. [PMID: 26382091 DOI: 10.1016/j.clml.2015.07.644] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 07/13/2015] [Accepted: 07/28/2015] [Indexed: 12/20/2022]
Abstract
Systemic mastocytosis (SM) is defined as the accumulation of abnormal mast cells (MC) in 1 or more extracutaneous tissues. Symptoms are due to either MC activation or organ infiltration and vary depending on disease subtype. More benign forms of SM, such as indolent SM, result in a life expectancy similar to the general population, while more aggressive subtypes, such as MC leukemia (MCL), have a median survival measured on the order of months. Treatment of indolent SM is directed at controlling the symptoms associated with MC activation. In advanced forms, such as aggressive SM and MCL, agents targeting MC proliferation such as KIT tyrosine kinase inhibitors, cladribine, and thalidomide may be provided. Newer agents based on preclinical rationale are also being actively investigated. However, the only potentially curative therapy for aggressive SM/MCL remains hematopoietic stem cell transplantation. Given that SM is a relatively rare disease, clinicians are often underprepared to evaluate, diagnose, and effectively treat this clinically heterogeneous condition. Here we seek to familiarize clinicians with this orphan disease and review current and future treatment approaches.
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Arock M, Sotlar K, Akin C, Broesby-Olsen S, Hoermann G, Escribano L, Kristensen TK, Kluin-Nelemans HC, Hermine O, Dubreuil P, Sperr WR, Hartmann K, Gotlib J, Cross NCP, Haferlach T, Garcia-Montero A, Orfao A, Schwaab J, Triggiani M, Horny HP, Metcalfe DD, Reiter A, Valent P. KIT mutation analysis in mast cell neoplasms: recommendations of the European Competence Network on Mastocytosis. Leukemia 2015; 29:1223-32. [PMID: 25650093 PMCID: PMC4522520 DOI: 10.1038/leu.2015.24] [Citation(s) in RCA: 192] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 01/01/2015] [Accepted: 01/09/2015] [Indexed: 12/20/2022]
Abstract
Although acquired mutations in KIT are commonly detected in various categories of mastocytosis, the methodologies applied to detect and quantify the mutant type and allele burden in various cells and tissues are poorly defined. We here propose a consensus on methodologies used to detect KIT mutations in patients with mastocytosis at diagnosis and during follow-up with sufficient precision and sensitivity in daily practice. In addition, we provide recommendations for sampling and storage of diagnostic material as well as a robust diagnostic algorithm. Using highly sensitive assays, KIT D816V can be detected in peripheral blood leukocytes from most patients with systemic mastocytosis (SM) that is a major step forward in screening and SM diagnosis. In addition, the KIT D816V allele burden can be followed quantitatively during the natural course or during therapy. Our recommendations should greatly facilitate diagnostic and follow-up investigations in SM in daily practice as well as in clinical trials. In addition, the new tools and algorithms proposed should lead to a more effective screen, early diagnosis of SM and help to avoid unnecessary referrals.
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Affiliation(s)
- Michel Arock
- Molecular Oncology and Pharmacology, LBPA CNRS UMR8113, Ecole Normale Supérieure de Cachan, Cachan, France
- Laboratory of Hematology, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Karl Sotlar
- Institute of Pathology, Ludwig-Maximilians-University, Munich, Germany
| | - Cem Akin
- Division of Allergy and Immunology, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA
| | - Sigurd Broesby-Olsen
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark
| | - Gregor Hoermann
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Luis Escribano
- Servicio Central de Citometria, Centro de Investigacion del Cancer (IBMCC, CSIC/USAL), IBSAL and Department of Medicine, University of Salamanca, Salamanca, Spain
| | | | - Hanneke C. Kluin-Nelemans
- Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Olivier Hermine
- Clinical Hematology Department, Faculty of Medicine and AP-HP Necker-Enfants Malades, Paris Descartes University, Paris, France
| | - Patrice Dubreuil
- Signaling, Hematopoiesis and Mechanism of Oncogenesis, Inserm U1068, CRCM, Marseille, France
- Institut Paoli-Calmettes, Marseille, France
- Aix-Marseille University, UM 105, Marseille, France
- CNRS, UMR7258, CRCM, Marseille; France
| | - Wolfgang R. Sperr
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Karin Hartmann
- Department of Dermatology, University of Cologne, Cologne, Germany
| | - Jason Gotlib
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, USA
| | - Nicholas CP Cross
- Wessex Regional Genetics Laboratory, Salisbury, and Faculty of Medicine, University of Southampton, Southampton, England
| | | | - Andres Garcia-Montero
- Servicio Central de Citometria, Centro de Investigacion del Cancer (IBMCC, CSIC/USAL), IBSAL and Department of Medicine, University of Salamanca, Salamanca, Spain
| | - Alberto Orfao
- Servicio Central de Citometria, Centro de Investigacion del Cancer (IBMCC, CSIC/USAL), IBSAL and Department of Medicine, University of Salamanca, Salamanca, Spain
| | - Juliana Schwaab
- III. Medizinische Klinik, Hematology and Oncology, Universitätsmedizin Mannheim, Mannheim, Germany
| | - Massimo Triggiani
- Division of Allergy and Clinical Immunology, University of Salerno, Salerno, Italy
| | - Hans-Peter Horny
- Institute of Pathology, Ludwig-Maximilians-University, Munich, Germany
| | | | - Andreas Reiter
- III. Medizinische Klinik, Hematology and Oncology, Universitätsmedizin Mannheim, Mannheim, Germany
| | - Peter Valent
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
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Arock M, Akin C, Hermine O, Valent P. Current treatment options in patients with mastocytosis: status in 2015 and future perspectives. Eur J Haematol 2015; 94:474-90. [PMID: 25753531 DOI: 10.1111/ejh.12544] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2015] [Indexed: 12/20/2022]
Abstract
Mastocytosis is a term referring to a heterogeneous group of disorders characterized by abnormal mast cell (MC) accumulation in the skin and/or internal organs. In children, the disease involves mostly the skin (cutaneous mastocytosis; CM), whereas in adults, the disease is usually systemic (systemic mastocytosis; SM). Advanced SM variants with end-organ damage and reduced life expectancy have also been described, but are rare. Clinical signs and symptoms in SM result from excessive mediator release by MCs and, in aggressive forms, from organ failure related to MC infiltration. As a consequence, treatment of indolent SM aims primarily at the control of symptoms caused by MC mediator release. By contrast, in advanced SM, such as aggressive SM, MC leukemia, and MC sarcoma, intensive (chemo)therapy with or without allogeneic stem cell transplantation has to be considered. In addition, activating mutations in KIT (mostly KIT D816V in adults) are found in most patients with SM, so that targeted therapies aimed at blocking mutant KIT variants or/and downstream signaling pathways are currently being developed. Other targets, such as specific surface antigens expressed on neoplastic MCs, might be considered for the development of future therapies in advanced SM.
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Affiliation(s)
- Michel Arock
- Molecular Oncology and Pharmacology, LBPA CNRS UMR8113, Ecole Normale Supérieure de Cachan, Cachan, France.,Laboratory of Hematology, Pitié-Salpêtrière Hospital, Paris, France
| | - Cem Akin
- Division of Allergy and Immunology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Olivier Hermine
- Clinical Hematology Department, Faculty of Medicine and AP-HP Necker-Enfants Malades, Paris Descartes University, Paris, France.,Imagine Institute, INSERM U1168, CNRS ERL 8654, National Reference Center on Mastocytosis, Paris, France
| | - Peter Valent
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
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Pardanani A. Systemic mastocytosis in adults: 2015 update on diagnosis, risk stratification, and management. Am J Hematol 2015; 90:250-62. [PMID: 25688753 DOI: 10.1002/ajh.23931] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 12/24/2014] [Indexed: 12/20/2022]
Abstract
DISEASE OVERVIEW Systemic mastocytosis (SM) results from a clonal proliferation of abnormal mast cells (MC) in one or more extracutaneous organs. DIAGNOSIS The major criterion is presence of multifocal clusters of morphologically abnormal MC in the bone marrow. Minor diagnostic criteria include elevated serum tryptase level, abnormal MC expression of CD25 and/or CD2, and presence of KITD816V. RISK STRATIFICATION The 2008 World Health Organization classification of SM has been shown to be prognostically relevant. Classification of SM patients into indolent SM (ISM), aggressive SM (ASM), SM associated with a clonal non-MC lineage disease (SM-AHNMD), and mast cell leukemia (MCL) subgroups is a useful first step in establishing prognosis. MANAGEMENT SM treatment is generally palliative. ISM patients have a normal life expectancy and receive symptom-directed therapy; infrequently, cytoreductive therapy may be indicated for refractory symptoms. ASM patients have disease-related organ dysfunction; interferon-α (+/-corticosteroids) can control dermatological, hematological, gastrointestinal, skeletal, and mediator-release symptoms, but is hampered by poor tolerability. Similarly, cladribine has broad therapeutic activity, with particular utility when rapid MC debulking is indicated; the main toxicity is myelosuppression. Imatinib has a therapeutic role in the presence of an imatinib-sensitive KIT mutation or in KITD816-unmutated patients. Treatment of SM-AHNMD is governed primarily by the non-MC neoplasm; hydroxyurea has modest utility in this setting; there is a role for allogeneic stem cell transplantation in select cases. Investigational Drugs: Recent data confirms midostaurin's significant anti-MC activity in patients with advanced SM.
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Affiliation(s)
- Animesh Pardanani
- Division of Hematology; Mayo Clinic; Rochester Minnesota
- Department of Medicine; Mayo Clinic; Rochester Minnesota
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Bibi S, Langenfeld F, Jeanningros S, Brenet F, Soucie E, Hermine O, Damaj G, Dubreuil P, Arock M. Molecular Defects in Mastocytosis. Immunol Allergy Clin North Am 2014; 34:239-62. [DOI: 10.1016/j.iac.2014.01.009] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Cardet JC, Akin C, Lee MJ. Mastocytosis: update on pharmacotherapy and future directions. Expert Opin Pharmacother 2014; 14:2033-45. [PMID: 24044484 DOI: 10.1517/14656566.2013.824424] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Mastocytosis is a disorder characterized by abnormal mast cell (MC) accumulation in skin and internal organs such as bone marrow. The disease follows a benign course in most patients with cutaneous and indolent systemic mastocytosis (SM); however, advanced variants associated with decreased life expectancy also exist. Pharmacotherapy of mastocytosis is aimed at the control of symptoms caused by MC mediator release, treatment of comorbidities and cytoreductive therapies in advanced variants. AREAS COVERED This article will cover the general treatment principles of anti-MC mediator and cytoreductive therapies of mastocytosis. The literature discussed was retrieved with PubMed using the search terms 'treatment of mastocytosis,' 'mastocytosis antimediator therapy' and looking for important cross-references. EXPERT OPINION Pharmacotherapy of mastocytosis should be individualized for each patient considering the category of disease, reduction of risk of anaphylaxis, constitutional symptoms and comorbidities including osteoporosis. Cytoreductive therapies are generally reserved for patients with aggressive mastocytosis (ASM), MC leukemia (MCL) and MC sarcoma (MCS); however, some patients with indolent disease and recurrent anaphylactic episodes not responsive to antimediator therapies may also be considered for cytoreduction on a case-by-case basis.
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Affiliation(s)
- Juan Carlos Cardet
- Brigham and Women's Hospital, Division of Rheumatology, Allergy, Immunology, Mastocytosis Center, Department of Medicine , One Jimmy Fund Way, Smith Building, Room 626B, Boston, MA 02115 , USA
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Alvarez-Twose I, Matito A, Sánchez-Muñoz L, Morgado JM, Escribano L. Management of adult mastocytosis. Expert Opin Orphan Drugs 2014. [DOI: 10.1517/21678707.2014.884922] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Sperr WR, Valent P. Diagnosis, progression patterns and prognostication in mastocytosis. Expert Rev Hematol 2014; 5:261-74. [DOI: 10.1586/ehm.12.12] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Melikian AL, Subortseva IN, Goriacheva SR, Kolosheinova TI, Vakhrusheva MV, Kovrigina AM, Sudarikov AB, Dvirnyk VN, Obukhova TN. [Mastocytosis. Review of the literature and description of clinical cases]. TERAPEVT ARKH 2014; 86:127-34. [PMID: 25804054 DOI: 10.17116/terarkh20148612127-134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The term mastocytosis (MC) encompasses a group of rare diseases characterized by the tumorous proliferation of clonal mast cells and the infiltration of one or several organs. The clinical picture of MC is extremely diverse from skin lesions that can spontaneously regress to the aggressive disease forms associated with organ dysfunction and short survival. Nowadays, the 2008 WHO classification identifies 7 MC subtypes. The disease is diagnosed on the basis of its clinical manifestations and detection of tumorous mast cell infiltrations via morphological, immunohistochemical, immunophenotypic, genetic, and molecular examinations. Abnormal mast cells are characterized by the atypical morphology and pathological expression of CD25 and CD2 antigens. Enhanced serum tryptase activity is a common sign in all MC subtypes. More than 90% of the patients have D816V KIT mutations in the mast cells. This paper reviews the literature. Three cases are described as a clinical example in patients with different MC subtypes.
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Mihalik N, Hidvégi B, Hársing J, Várkonyi J, Csomor J, Kovalszky I, Marschalkó M, Kárpáti S. Clinical observations in cutan mastocytosis. Orv Hetil 2013; 154:1469-75. [DOI: 10.1556/oh.2013.29702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Introduction: Mastocytosis is a clonal mast cell proliferative disease, devided into cutaneous and systemic forms. The characteristic symptoms are caused by neoplastic mast cell infiltrations in different organs and/or the release of mediators. Aim: The aim of the authors was to summarize their clinical observations in patients with mastocytosis. Method: 22 adult patients diagnosed consecutively with mastocytosis were enrolled in the study. Skin and bone marrow biopsies were taken to establish the diagnosis and perform c-KIT mutation (D816V) analysis. Results: One of the 22 patients had teleangiectasia macularis eruptiva perstans, while 20/22 patients had urticaria pigmentosa. All patients had cutaneous lesions. In 12 patients iliac crest biopsy was performed and 9 of them had bone marrow involvement, classified as indolent systemic mastocytosis. The c-kit mutation D816V was found in one subject both in skin and bone marrow samples. The patients were treated with antihistamine, PUVA, interferon-α or imatinib. Conclusions: The authors draw attention to this rare disease in order to help recognition of relevant signs and symptoms and establish an early diagnosis. Orv. Hetil., 2013, 154, 1469–1475.
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Affiliation(s)
- Noémi Mihalik
- Semmelweis Egyetem, Általános Orvostudományi Kar Bőr-, Nemikórtani és Bőronkológiai Klinika Budapest Mária u. 41. 1085
| | - Bernadett Hidvégi
- Semmelweis Egyetem, Általános Orvostudományi Kar Bőr-, Nemikórtani és Bőronkológiai Klinika Budapest Mária u. 41. 1085
| | - Judit Hársing
- Semmelweis Egyetem, Általános Orvostudományi Kar Bőr-, Nemikórtani és Bőronkológiai Klinika Budapest Mária u. 41. 1085
| | - Judit Várkonyi
- Semmelweis Egyetem, Általános Orvostudományi Kar III. Belgyógyászati Klinika Budapest
| | - Judit Csomor
- Semmelweis Egyetem, Általános Orvostudományi Kar I. Patológiai és Kísérleti Rákkutató Intézet Budapest
| | - Ilona Kovalszky
- Semmelweis Egyetem, Általános Orvostudományi Kar I. Patológiai és Kísérleti Rákkutató Intézet Budapest
| | - Márta Marschalkó
- Semmelweis Egyetem, Általános Orvostudományi Kar Bőr-, Nemikórtani és Bőronkológiai Klinika Budapest Mária u. 41. 1085
| | - Sarolta Kárpáti
- Semmelweis Egyetem, Általános Orvostudományi Kar Bőr-, Nemikórtani és Bőronkológiai Klinika Budapest Mária u. 41. 1085
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Pardanani A. Systemic mastocytosis in adults: 2013 update on diagnosis, risk stratification, and management. Am J Hematol 2013; 88:612-24. [PMID: 23720340 DOI: 10.1002/ajh.23459] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 04/04/2013] [Indexed: 12/20/2022]
Abstract
DISEASE OVERVIEW Systemic mastocytosis (SM) results from a clonal proliferation of abnormal mast cells (MC) in one or more extracutaneous organs. DIAGNOSIS The major criterion is presence of multifocal clusters of morphologically abnormal MC in the bone marrow. Minor diagnostic criteria include elevated serum tryptase level, abnormal MC expression of CD25 and/or CD2, and presence of KITD816V. RISK STRATIFICATION The 2008 World Health Organization (WHO) classification of SM has been shown to be prognostically relevant. Classification of SM patients into indolent (SM), aggressive SM (ASM), SM associated with a clonal non-MC lineage disease (SM-AHNMD) and mast cell leukemia (MCL) subgroups is a useful first step in establishing prognosis. MANAGEMENT SM treatment is generally palliative. ISM patients have a normal life expectancy and receive symptom-directed therapy; infrequently, cytoreductive therapy may be indicated for refractory symptoms. ASM patients have disease-related organ dysfunction; interferon-α (±corticosteroids) can control dermatological, hematological, gastrointestinal, skeletal, and mediator-release symptoms, but is hampered by poor tolerability. Similarly, cladribine has broad therapeutic activity, with particular utility when rapid MC debulking is indicated; the main toxicity is myelosuppression. Imatinib has a therapeutic role in the presence of an imatinib-sensitive KIT mutation or in KITD816-unmutated patients. Treatment of SM-AHNMD is governed primarily by the non-MC neoplasm; hydroxyurea has modest utility in this setting. INVESTIGATIONAL DRUGS Dasatinib's in vitro anti- KITD816V activity has not translated into significant therapeutic activity in most SM patients. In contrast, recently updated data confirms Midostaurin's significant anti-MC activity in patients with advanced SM.
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Affiliation(s)
- Animesh Pardanani
- Division of Hematology, Department of Medicine; Mayo Clinic; Rochester Minnesota
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How I treat patients with indolent and smoldering mastocytosis (rare conditions but difficult to manage). Blood 2013; 121:3085-94. [DOI: 10.1182/blood-2013-01-453183] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Abstract
Indolent systemic mastocytosis (SM) patients have a varied clinical presentation, ranging from predominantly cutaneous symptoms to recurrent systemic symptoms (eg, flushing, palpitations, dyspepsia, diarrhea, bone pain) that can be severe and potentially life threatening (anaphylaxis). Mastocytosis patients without skin involvement pose a diagnostic challenge; a high index of suspicion is needed in those with mast cell–degranulation symptoms, including anaphylaxis following Hymenoptera stings or other triggers. Modern-era molecular and flow-cytometric diagnostic methods are very sensitive and can detect minimal involvement of bone marrow with atypical/clonal mast cells; in some cases, full diagnostic criteria for SM are not fulfilled. An important aspect of treatment is avoidance of known symptom triggers; other treatment principles include a stepwise escalation of antimediator therapies and consideration of cytoreductive therapies for those with treatment-refractory symptoms. The perioperative management of mastocytosis patients is nontrivial; a multidisciplinary preoperative assessment, adequate premedications, and close intra- and postoperative monitoring are critical. Smoldering mastocytosis is a variant with high systemic mast cell burden. While its clinical course can be variable, there is greater potential need for cytoreductive therapies (eg, interferon-alpha, cladribine) in this setting. A systematic approach to the diagnosis and treatment of indolent SM using a case-based approach of representative clinical scenarios is presented here.
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International Working Group-Myeloproliferative Neoplasms Research and Treatment (IWG-MRT) & European Competence Network on Mastocytosis (ECNM) consensus response criteria in advanced systemic mastocytosis. Blood 2013; 121:2393-401. [PMID: 23325841 DOI: 10.1182/blood-2012-09-458521] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Systemic mastocytosis (SM) is characterized by accumulation of neoplastic mast cells and is classified into indolent and aggressive forms. The latter include aggressive SM (ASM), mast cell leukemia (MCL), and SM associated with a myeloid neoplasm wherein 1 or both disease compartments exhibit advanced features. These variants, henceforth collectively referred to as advanced SM for the purposes of this report, are typically characterized by organ damage and shortened survival duration. In contrast to indolent SM, in which symptoms are usually managed by noncytotoxic antimediator therapy, cytoreduction is usually necessary for disease control in advanced SM. Unfortunately, current drug treatment of these patients rarely results in complete clinical and histopathologic remissions or improved survival time. Previously defined response criteria were adapted to the heterogeneous presentations of advanced SM and the limited effects of available drugs. However, recent advances in understanding the molecular pathogenesis of SM and the corresponding prospect in targeted therapy make it a priority to modify these criteria. Our current study is the product of an international group of experts and summarizes the challenges in accomplishing this task and forwards a new proposal for response criteria, which builds on prior proposals and should facilitate response evaluation in clinical trials.
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Sandes AF, Medeiros RSS, Rizzatti EG. Diagnosis and treatment of mast cell disorders: practical recommendations. SAO PAULO MED J 2013; 131:264-74. [PMID: 24141298 PMCID: PMC10871832 DOI: 10.1590/1516-3180.2013.1314590] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Revised: 08/28/2012] [Accepted: 03/20/2013] [Indexed: 01/08/2023] Open
Abstract
CONTEXT AND OBJECTIVE The term mastocytosis covers a group of rare disorders characterized by neoplastic proliferation and accumulation of clonal mast cells in one or more organs. The aim of this study was to assess the principal elements for diagnosing and treating these disorders. DESIGN AND SETTING Narrative review of the literature conducted at Grupo Fleury, São Paulo, Brazil. METHODS This study reviewed the scientific papers published in the PubMed, Embase (Excerpta Medica Database), Lilacs (Literatura Latino-Americana e do Caribe em Ciências da Saúde) and Cochrane Library databases that were identified using the search term "mastocytosis." RESULTS The clinical presentation of mastocytosis is remarkably heterogeneous and ranges from skin lesions that may regress spontaneously to aggressive forms associated with organ failure and short survival. Currently, seven subtypes of mastocytosis are recognized through the World Health Organization classification system for hematopoietic tumors. These disorders are diagnosed based on clinical manifestations and on identification of neoplastic mast cells using morphological, immunophenotypic, genetic and molecular methods. Abnormal mast cells display atypical and frequently spindle-shaped morphology, and aberrant expression of the CD25 and CD2 antigens. Elevation of serum tryptase is a common finding in some subtypes, and more than 90% of the patients present the D816V KIT mutation in mast cells. CONCLUSION Here, we described the most common signs and symptoms among patients with mastocytosis and suggested a practical approach for the diagnosis, classification and initial clinical treatment of mastocytosis.
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Affiliation(s)
- Alex Freire Sandes
- MD, PhD. Medical Consultant in Hematology, Division of Laboratory Medicine and Pathological Anatomy, Grupo Fleury, São Paulo, Brazil.
| | | | - Edgar Gil Rizzatti
- MD, PhD. Medical Consultant in Hematology, Division of Laboratory Medicine and Pathological Anatomy, Grupo Fleury, São Paulo, Brazil.
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Abstract
Mast cell leukemia (MCL) is a very rare form of aggressive systemic mastocytosis accounting for < 1% of all mastocytosis. It may appear de novo or secondary to previous mastocytosis and shares more clinicopathologic aspects with systemic mastocytosis than with acute myeloid leukemia. Symptoms of mast cell activation-involvement of the liver, spleen, peritoneum, bones, and marrow-are frequent. Diagnosis is based on the presence of ≥ 20% atypical mast cells in the marrow or ≥ 10% in the blood; however, an aleukemic variant is frequently encountered in which the number of circulating mast cells is < 10%. The common phenotypic features of pathologic mast cells encountered in most forms of mastocytosis are unreliable in MCL. Unexpectedly, non-KIT D816V mutations are frequent and therefore, complete gene sequencing is necessary. Therapy usually fails and the median survival time is < 6 months. The role of combination therapies and bone marrow transplantation needs further investigation.
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Gotlib J, Akin C. Mast cells and eosinophils in mastocytosis, chronic eosinophilic leukemia, and non-clonal disorders. Semin Hematol 2012; 49:128-37. [PMID: 22449623 DOI: 10.1053/j.seminhematol.2012.01.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Mast cells and eosinophils often travel in the same biologic circles. In non-clonal states, such as allergic and inflammatory conditions, cell-to-cell contact and the pleiotropic actions of multiple cytokines and chemokines, derived from local tissues or mast cells themselves, foster the co-recruitment of these cells to the same geographic cellular niche. While eosinophils and mast cells serve critical roles as part of the host immune response and in maintenance of normal homeostasis, these cell types can undergo neoplastic transformation due to the development of clonal molecular abnormalities that arise in early hematopoietic progenitors. The dysregulated tyrosine kinases, D816V KIT and FIP1L1-PDGFRA, are the prototypic oncogenic lesions resulting in systemic mastocytosis (SM) and chronic eosinophilic leukemia, respectively. We review the pathobiology of these myeloproliferative neoplasms (MPNs) with a focus on the relationship between mast cells and eosinophils, and discuss murine models, which further elucidate how the phenotype of these diseases can be influenced by stem cell factor (SCF) and expression of the potent eosinophilopoietic cytokine, interleukin-5 (IL-5). Therapy of SM and FIP1L1-PDGFRA-positive disease and the prognostic relevance of increased peripheral blood and tissue mast cells in hematolymphoid malignancies will also be addressed.
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Affiliation(s)
- Jason Gotlib
- Stanford University School of Medicine/Stanford Cancer Institute, Stanford, CA, USA
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