Systemic mastocytosis in adults: 2012 Update on diagnosis, risk stratification, and management

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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 prognostic relevance of the 2008 World Health Organization (WHO) classification of SM has recently been confirmed. 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, preliminary data suggest that Midostaurin may produce significant decreases in MC burden in some patients.

Original languageEnglish (US)
Pages (from-to)401-411
Number of pages11
JournalAmerican Journal of Hematology
Volume87
Issue number4
DOIs
StatePublished - Apr 2012

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Systemic Mastocytosis
Risk Management
Mast Cells
4'-N-benzoylstaurosporine
Therapeutics
Mast-Cell Leukemia
Cladribine
Investigational Drugs
Tryptases
Hydroxyurea
Cell Lineage
Life Expectancy
Interferons
Adrenal Cortex Hormones
Bone Marrow

ASJC Scopus subject areas

  • Hematology

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Systemic mastocytosis in adults : 2012 Update on diagnosis, risk stratification, and management. / Pardanani, Animesh D.

In: American Journal of Hematology, Vol. 87, No. 4, 04.2012, p. 401-411.

Research output: Contribution to journalArticle

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