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Sordi B, Vanderwert F, Crupi F, Gesullo F, Zanotti R, Bonadonna P, Crosera L, Elena C, Fiorelli N, Ferrari J, Grifoni F, Sciumè M, Parente R, Triggiani M, Palterer B, Mecheri V, Almerigogna F, Santi R, Di Medio L, Brandi ML, Iorno ML, Ciardetti I, Bencini S, Annunziato F, Mannarelli C, Pieri L, Guglielmelli P, Mannelli F, Vannucchi AM. Disease correlates and clinical relevance of hereditary α-tryptasemia in patients with systemic mastocytosis. J Allergy Clin Immunol 2023; 151:485-493.e11. [PMID: 36309122 DOI: 10.1016/j.jaci.2022.09.038] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 08/05/2022] [Accepted: 09/15/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Systemic mastocytosis (SM) encompasses a heterogeneous group of clonal disorders characterized by abnormal expansion of mast cells (MCs). Beyond KIT and other genes recurrently mutated in myeloid neoplasms, several genetic variants have been described as predisposing to the development of the disease and influencing its clinical phenotype. Increased copy number variants of the TPSAB1 gene were identified as a cause of nonclonal elevated tryptasemia and defined as hereditary α-tryptasemia (HαT). Moreover, HαT is enriched in patients with SM, where it can affect the incidence of mediator-related symptoms. OBJECTIVE In a multicenter data set of 444 patients with MC disorders, we aimed to investigate the clinical correlates of germline TPSAB1 copy number gains. METHODS Droplet digital PCR was performed in all cases to ascertain the presence of HαT. Clinical history along with blood values and bone marrow examination were analyzed. RESULTS We confirmed a higher incidence of HαT+ cases (n = 59, 13.3%) in patients diagnosed with mastocytosis with respect to the general population (approximately 5%). HαT+ patients were characterized by a lower MC-associated disease burden and higher levels of tryptase. Several disease variables were coherent with this pattern, from bone marrow MC infiltration to MC-related histopathologic traits, which also accounted for a significantly higher incidence of clonal MC activation syndrome in HαT+ (10.2%) compared to HαT- (3.4%, P = .029) patients. We also confirmed that HαT+ carriers had a significantly higher frequency of anaphylaxis, without relevant differences for other clinical manifestations. CONCLUSION These findings on a large patient series support and extend previous data, and suggest that knowledge of HαT status may be useful for personalized management of patients with SM.
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Affiliation(s)
- Benedetta Sordi
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy
| | - Fiorenza Vanderwert
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy
| | - Francesca Crupi
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy
| | - Francesca Gesullo
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy
| | - Roberta Zanotti
- UO Ematologia, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Patrizia Bonadonna
- UO Allergologia, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Lara Crosera
- UO Ematologia, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Chiara Elena
- Divisione di Ematologia, IRCCS S. Matteo Hospital Foundation, Pavia, Italy
| | - Nicolas Fiorelli
- Dipartimento di Medicina Molecolare, Università di Pavia, Pavia, Italy
| | | | - Federica Grifoni
- UOC Ematologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Mariarita Sciumè
- UOC Ematologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Roberta Parente
- Dipartimento di Medicina, Divisione di Allergologia e Immunologia Clinica, Università di Salerno, Salerno, Italy
| | - Massimo Triggiani
- Dipartimento di Medicina, Divisione di Allergologia e Immunologia Clinica, Università di Salerno, Salerno, Italy
| | - Boaz Palterer
- Centro di Diagnostica Citofluorimetrica e Immunoterapia, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Florence, Italy
| | - Valentina Mecheri
- SOD Immunoallergologia, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Florence, Italy
| | - Fabio Almerigogna
- SOD Immunoallergologia, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Florence, Italy
| | - Raffaella Santi
- Sezione di Patologia, Dipartimento di Scienze della Salute, Università di Florence, Florence, Italy
| | - Lisa Di Medio
- SOD Malattie del Metabolismo Minerale e Osseo, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Maria Luisa Brandi
- SOD Malattie del Metabolismo Minerale e Osseo, Azienda Ospedaliera Universitaria Careggi, Florence, Italy; FirmoLab, Fondazione FIRMO, Florence, Italy
| | - Maria Loredana Iorno
- Allergologia e Immunologia Clinica Azienda Toscana Centro Ospedale S. Giovanni di Dio, Florence, Italy
| | - Isabella Ciardetti
- Dipartimento di Scienze della Salute, sezione Dermatologia, Università degli Studi di Florence, Florence, Italy
| | - Sara Bencini
- Centro di Diagnostica Citofluorimetrica e Immunoterapia, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Florence, Italy
| | - Francesco Annunziato
- Centro di Diagnostica Citofluorimetrica e Immunoterapia, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Florence, Italy
| | - Carmela Mannarelli
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy
| | - Lisa Pieri
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy
| | - Paola Guglielmelli
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy
| | - Francesco Mannelli
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy
| | - Alessandro M Vannucchi
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy.
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Adverse Prognostic Impact of the KIT D816V Transcriptional Activity in Advanced Systemic Mastocytosis. Int J Mol Sci 2021; 22:ijms22052562. [PMID: 33806359 PMCID: PMC7961551 DOI: 10.3390/ijms22052562] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 11/17/2022] Open
Abstract
In systemic mastocytosis (SM), qualitative and serial quantitative assessment of the KIT D816V mutation is of diagnostic and prognostic relevance. We investigated peripheral blood and bone marrow samples of 161 patients (indolent SM (ISM), n = 40; advanced SM, AdvSM, n = 121) at referral and during follow-up for the KIT D816V variant allele frequency (VAF) at the DNA-level and the KIT D816V expressed allele burden (EAB) at the RNA-level. A round robin test with four participating laboratories revealed an excellent correlation (r > 0.99, R2 > 0.98) between three different DNA-assays. VAF and EAB strongly correlated in ISM (r = 0.91, coefficient of determination, R2 = 0.84) but only to a lesser extent in AdvSM (r = 0.71; R2 = 0.5). However, as compared to an EAB/VAF ratio ≤2 (cohort A, 77/121 patients, 64%) receiver operating characteristic (ROC) analysis identified an EAB/VAF ratio of >2 (cohort B, 44/121 patients, 36%) as predictive for an advanced phenotype and a significantly inferior median survival (3.3 vs. 11.7 years; p = 0.005). In terms of overall survival, Cox-regression analysis was only significant for the EAB/VAF ratio >2 (p = 0.006) but not for VAF or EAB individually. This study demonstrates for the first time that the transcriptional activity of KIT D816V may play an important role in the pathophysiology of SM.
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Mimiola E, Bomben R, De Matteis G, Perbellini O, Guglielmelli P, Bonifacio M, Parisi A, Gattei V, Zamò A, Mannelli F, García Montero AC, Zanotti R. Systemic mastocytosis associated with myelodysplastic/myeloproliferative neoplasms with ring sideroblasts and thrombocytosis: Report of three cases. Hematol Oncol 2019; 37:628-633. [PMID: 31523839 DOI: 10.1002/hon.2680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 09/04/2019] [Accepted: 09/12/2019] [Indexed: 12/30/2022]
Abstract
The association of systemic mastocytosis with another hematologic neoplasia of myeloid or lymphoid origin is recognized as an advanced subvariant of mastocytosis. Here, we report the association of indolent or smoldering systemic mastocytosis with three cases of myelodysplastic/myeloproliferative neoplasms with ring sideroblasts and thrombocytosis, a recently recognized disease characterized by SF3B1 mutations. The hierarchical pattern of KIT, SF3B1, JAK2, and additional mutations was studied in whole and fractionated subpopulations of peripheral blood cells and whole bone marrow. In two cases, we could demonstrate a multilineage D816V KIT mutation, involving all myeloid lineages in one patient and also the lymphoid series in the other. Two patients displaying both SF3B1 and V617F JAK2 mutations had a very poor prognosis. Another patient bearing SF3B1, but not V617F JAK2 mutation, had a favorable response to erythropoietin treatment and long survival.
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Affiliation(s)
- Elda Mimiola
- Section of Hematology, Multidisciplinary Outpatients Clinics for Mastocytosis, Department of Medicine, AOUI, Verona, Italy
- Department of Immunohematology and Transfusion Medicine, ASST, Mantova, Italy
| | - Riccardo Bomben
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico, IRCCS, Aviano, Italy
| | - Giovanna De Matteis
- Section of Clinical Biochemistry, Department of Life and Reproduction Sciences, AOUI, Verona, Italy
| | - Omar Perbellini
- Department of Cell Therapy and Hematology, Ospedale San Bortolo, Vicenza, Italy
| | - Paola Guglielmelli
- Center of Research and Innovation of Myeloproliferative Neoplasms, Careggi University Hospital, Florence, Italy
| | - Massimiliano Bonifacio
- Section of Hematology, Multidisciplinary Outpatients Clinics for Mastocytosis, Department of Medicine, AOUI, Verona, Italy
| | | | - Valter Gattei
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico, IRCCS, Aviano, Italy
| | - Alberto Zamò
- Department of Oncology, University of Turin, Turin, Italy
| | - Francesco Mannelli
- Center of Research and Innovation of Myeloproliferative Neoplasms, Careggi University Hospital, Florence, Italy
| | | | - Roberta Zanotti
- Section of Hematology, Multidisciplinary Outpatients Clinics for Mastocytosis, Department of Medicine, AOUI, Verona, Italy
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Liu Z, Wang W, Zheng C, Tan Y, Chen X, Xu J, Xu Z, Ren F, Zhang Y, Li G, Chang J, Wang H. Clinical significance of droplet digital PCR quantitative monitoring of KIT gene mutation levels in core binding factor leukemia. Int J Lab Hematol 2018; 40:e124-e126. [PMID: 29984546 DOI: 10.1111/ijlh.12883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Zhuang Liu
- Department of Hematology, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Wenjun Wang
- Department of Hematology, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Chaofeng Zheng
- Department of Hematology, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yanhong Tan
- Department of Hematology, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Xiuhua Chen
- Department of Hematology, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Jing Xu
- Department of Hematology, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Zhifang Xu
- Department of Hematology, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Fanggang Ren
- Department of Hematology, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yaofang Zhang
- Department of Hematology, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Guoxia Li
- Department of Hematology, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Jianmei Chang
- Department of Hematology, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Hongwei Wang
- Department of Hematology, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
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Kristensen T, Vestergaard H, Bindslev‐Jensen C, Mortz CG, Kjaer HF, Ollert M, Møller MB, Broesby‐Olsen S. Prospective evaluation of the diagnostic value of sensitive KIT D816V mutation analysis of blood in adults with suspected systemic mastocytosis. Allergy 2017; 72:1737-1743. [PMID: 28432683 DOI: 10.1111/all.13187] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Sensitive KIT D816V mutation analysis of blood has been proposed to guide bone marrow (BM) investigation in suspected systemic mastocytosis (SM). The aim of this prospective study was for the first time to compare the D816V status of the "screening blood sample" used to guide BM biopsy in suspected SM to the outcome of the subsequent BM investigation. METHODS Fifty-eight adult patients with suspected SM were included. The outcome of sensitive KIT D816V analysis of blood was compared to the result of the BM investigation. RESULTS Screening blood samples from 44 of 58 patients tested D816V-positive. In 43 of these, SM was subsequently diagnosed in the BM investigation. One patient with a D816V-positive screening sample was diagnosed with monoclonal MC activation syndrome. Screening blood samples from 14 patients tested D816V-negative. SM was subsequently diagnosed in five of these, whereas nine patients did not fulfill any diagnostic SM criteria (excluding tryptase criterion). Of the 48 SM patients, 90% tested D816V-positive. Thirteen SM patients presented with Hymenoptera venom-induced anaphylaxis, no skin lesions, and baseline serum tryptase ≤20 ng/mL. Of these, 92% tested D816V-positive in the screening blood sample. CONCLUSION This prospective study demonstrates that a D816V-positive result in a screening blood sample identifies SM among patients with hymenoptera venom-induced anaphylaxis in whom the diagnosis would most probably have been missed, with potential severe implications. The observed false-negative screening results also underline that BM investigation is mandatory in all adult patients with clear signs of, or highly suspected SM, regardless of the KIT mutation status.
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Affiliation(s)
- T. Kristensen
- Department of Pathology Odense University Hospital Odense Denmark
| | - H. Vestergaard
- Department of Hematology Odense University Hospital Odense Denmark
| | - C. Bindslev‐Jensen
- Department of Dermatology and Allergy Centre Odense University Hospital Odense Denmark
- Odense Research Center for Anaphylaxis (ORCA) Odense University Hospital Odense Denmark
| | - C. G. Mortz
- Department of Dermatology and Allergy Centre Odense University Hospital Odense Denmark
- Odense Research Center for Anaphylaxis (ORCA) Odense University Hospital Odense Denmark
| | - H. F. Kjaer
- Department of Dermatology and Allergy Centre Odense University Hospital Odense Denmark
- Odense Research Center for Anaphylaxis (ORCA) Odense University Hospital Odense Denmark
| | - M. Ollert
- Odense Research Center for Anaphylaxis (ORCA) Odense University Hospital Odense Denmark
- Department of Infection and Immunity Luxembourg Institute of Health Luxembourg
| | - M. B. Møller
- Department of Pathology Odense University Hospital Odense Denmark
| | - S. Broesby‐Olsen
- Department of Dermatology and Allergy Centre Odense University Hospital Odense Denmark
- Odense Research Center for Anaphylaxis (ORCA) Odense University Hospital Odense Denmark
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