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Dahlin JS, Nilsson G. Systemic mastocytosis: dying or survivin. Blood 2024; 143:945-947. [PMID: 38483409 DOI: 10.1182/blood.2023023532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2024] Open
Affiliation(s)
| | - Gunnar Nilsson
- Karolinska Institutet
- Karolinska University Hospital
- Uppsala University
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2
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Greiner G, Witzeneder N, Klein K, Tangermann S, Kodajova P, Jaeger E, Ratzinger F, Gerner MC, Jawhar M, Baumgartner S, Fruehwirth K, Schmetterer KG, Zuber J, Gleixner KV, Mayerhofer M, Schwarzinger I, Simonitsch-Klupp I, Esterbauer H, Baer C, Walter W, Meggendorfer M, Strassl R, Haferlach T, Hartmann K, Kenner L, Sperr WR, Reiter A, Sexl V, Arock M, Valent P, Hoermann G. Tumor necrosis factor α promotes clonal dominance of KIT D816V+ cells in mastocytosis: role of survivin and impact on prognosis. Blood 2024; 143:1006-1017. [PMID: 38142424 DOI: 10.1182/blood.2023020515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 12/26/2023] Open
Abstract
ABSTRACT Systemic mastocytosis (SM) is defined by the expansion and accumulation of neoplastic mast cells (MCs) in the bone marrow (BM) and extracutaneous organs. Most patients harbor a somatic KIT D816V mutation, which leads to growth factor-independent KIT activation and accumulation of MC. Tumor necrosis factor α (TNF) is a proapoptotic and inflammatory cytokine that has been implicated in the clonal selection of neoplastic cells. We found that KIT D816V increases the expression and secretion of TNF. TNF expression in neoplastic MCs is reduced by KIT-targeting drugs. Similarly, knockdown of KIT or targeting the downstream signaling cascade of MAPK and NF-κB signaling reduced TNF expression levels. TNF reduces colony formation in human BM cells, whereas KIT D816V+ cells are less susceptible to the cytokine, potentially contributing to clonal selection. In line, knockout of TNF in neoplastic MC prolonged survival and reduced myelosuppression in a murine xenotransplantation model. Mechanistic studies revealed that the relative resistance of KIT D816V+ cells to TNF is mediated by the apoptosis-regulator BIRC5 (survivin). Expression of BIRC5 in neoplastic MC was confirmed by immunohistochemistry of samples from patients with SM. TNF serum levels are significantly elevated in patients with SM and high TNF levels were identified as a biomarker associated with inferior survival. We here characterized TNF as a KIT D816V-dependent cytokine that promotes clonal dominance. We propose TNF and apoptosis-associated proteins as potential therapeutic targets in SM.
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Affiliation(s)
- Georg Greiner
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
- Ihr Labor, Medical Diagnostic Laboratories, Vienna, Austria
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Nadine Witzeneder
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Klara Klein
- Institute of Pharmacology and Toxicology, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Simone Tangermann
- Unit of Laboratory Animal Pathology, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Petra Kodajova
- Unit of Laboratory Animal Pathology, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Eva Jaeger
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Marlene C Gerner
- Division of Biomedical Science, University of Applied Sciences FH Campus Wien, Vienna, Austria
| | - Mohamad Jawhar
- Department of Hematology and Oncology, University Hospital Mannheim, Mannheim, Germany
- Department of Hematology and Oncology, Helios Pforzheim, Pforzheim, Germany
| | - Sigrid Baumgartner
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Vienna, Austria
| | - Karin Fruehwirth
- Medical Central Laboratory, State Hospital Feldkirch, Feldkirch, Austria
| | - Klaus G Schmetterer
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Johannes Zuber
- Research Institute of Molecular Pathology, Vienna Biocenter, Vienna, Austria
| | - Karoline V Gleixner
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
- Division of Hematology and Hemostaseology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | | | - Ilse Schwarzinger
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Harald Esterbauer
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | | | | | | | - Robert Strassl
- Division of Clinical Virology, Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Karin Hartmann
- Division of Allergy, Department of Dermatology, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Lukas Kenner
- Unit of Laboratory Animal Pathology, University of Veterinary Medicine Vienna, Vienna, Austria
- Department of Pathology, Medical University of Vienna, Vienna, Austria
- Christian Doppler Laboratory for Applied Metabolomics, Vienna, Austria
- Center for Biomarker Research in Medicine, Graz, Austria
| | - Wolfgang R Sperr
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
- Division of Hematology and Hemostaseology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Andreas Reiter
- Department of Hematology and Oncology, University Hospital Mannheim, Mannheim, Germany
| | | | - Michel Arock
- Department of Hematological Biology and French National Reference Center for Mastocytosis (CEREMAST), Pitié-Salpêtrière Hospital, Paris Sorbonne University, Paris, France
| | - Peter Valent
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
- Division of Hematology and Hemostaseology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Gregor Hoermann
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
- Munich Leukemia Laboratory, Munich, Germany
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3
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Monahan R, Alfaro E, Ho H, Otani IM, Tsao LR. Hereditary alpha tryptasemia presenting as recurrent chemotherapy hypersensitivity reactions. Ann Allergy Asthma Immunol 2024; 132:270-273. [PMID: 38151098 DOI: 10.1016/j.anai.2023.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 12/29/2023]
Affiliation(s)
- Rose Monahan
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, UCSF Medical Center, San Francisco, California.
| | - Emely Alfaro
- UCSF School of Nursing, UCSF Adult Infusion Services, UCSF Medical Center, San Francisco, California
| | - Hansen Ho
- Department of Clinical Pharmacy, UCSF School of Pharmacy, UCSF Medical Center, San Francisco, California
| | - Iris M Otani
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, UCSF Medical Center, San Francisco, California
| | - Lulu R Tsao
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, UCSF Medical Center, San Francisco, California
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4
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Chen L, Wang Y, Gao X, Li Q. Reflectance confocal microscopy as a complementary diagnostic tool for greyish-brown dermatoses in children. Clin Exp Dermatol 2024; 49:259-262. [PMID: 37846602 DOI: 10.1093/ced/llad354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 09/01/2023] [Accepted: 10/12/2023] [Indexed: 10/18/2023]
Abstract
Mastocytosis, lichen planus pigmentosus (LPP), fixed drug eruption (FDE) and café-au-lait macules (CALM) have a similar appearance, often lead to misdiagnosis and missed diagnoses. At the outpatient clinic at Tianjin Children's Hospital in 21 patients with mastocytosis, 18 with LPP, 11 with FDE and 12 with CALM we evaluated the characteristics and distinguishing features of their dermatoses using reflectance confocal microscopy (RCM). In mastocytosis, the dermal papillary rings generally had a significantly increased bright refractive index and the superficial dermis was filled with moderate refractive flocculent material. In LPP, the dermal papillary rings were absent and numerous different-sized cellular structures were densely distributed in the superficial dermis. In FDE, the dermal papillary rings were intact with a significantly increased bright refractive index. In CALM, normal dermal papillary rings were detected with a uniformly slightly increased refractive index and no obvious abnormality in the superficial dermis. RCM allows for real-time visualization of the major key diagnostic and distinguishing features of four greyish-brown dermatoses in children.
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Affiliation(s)
- Lixin Chen
- Department of Dermatology, Tianjin Children's Hospital, Tianjin, China
| | - Ying Wang
- Department of Dermatology, Tianjin Children's Hospital, Tianjin, China
| | - Xibo Gao
- Department of Dermatology, Tianjin Children's Hospital, Tianjin, China
| | - Qinfeng Li
- Department of Dermatology, Tianjin Children's Hospital, Tianjin, China
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Gulen T. Using the Right Criteria for MCAS. Curr Allergy Asthma Rep 2024; 24:39-51. [PMID: 38243020 PMCID: PMC10866766 DOI: 10.1007/s11882-024-01126-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2024] [Indexed: 01/21/2024]
Abstract
PURPOSE OF REVIEW The current article aims to provide a comprehensive update on diagnostic criteria for mast cell activation syndrome (MCAS), addressing challenges in diagnosing and classifying MCAS and its variants. RECENT FINDINGS In recent years, there has been a significant increase in our knowledge regarding the underlying mechanisms responsible for the activation of mast cells (MCs) in various pathological conditions. Furthermore, a set of criteria and a classification for MCASs have been established. MCAS is characterized by the presence of typical clinical symptoms, a substantial elevation in serum tryptase levels during an attack compared to the patient's baseline tryptase levels, and a response to MC mediator-targeting therapy. In this report, a thorough examination was conducted on the contemporary literature relating to MCAS, with a focus on comparing the specificity, sensitivity, and robustness of MCAS-related parameters within proposals for diagnosing and classifying MCAS and its variants. Moreover, the significance of employing specific consensus criteria in the assessment and categorization of MCAS in individual patients was underscored, due to the escalating occurrence of patients receiving a misdiagnosis of MCAS based on nonspecific criteria.
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Affiliation(s)
- Theo Gulen
- Department of Respiratory Medicine and Allergy, K85, Karolinska University Hospital Huddinge, Stockholm, SE-14186, Sweden.
- Division of Immunology and Allergy, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
- Clinical Lung and Allergy Research Unit, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.
- Mastocytosis Centre Karolinska, Karolinska University Hospital Huddinge, Stockholm, Sweden.
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Svetina M, Šelb J, Lyons JJ, Korošec P, Rijavec M. Clinically accessible amplitude-based multiplex ddPCR assay for tryptase genotyping. Sci Rep 2024; 14:2416. [PMID: 38287122 PMCID: PMC10825142 DOI: 10.1038/s41598-024-52983-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/25/2024] [Indexed: 01/31/2024] Open
Abstract
Hereditary α tryptasemia (HαT) is an autosomal dominant trait characterized by increased TPSAB1 copy number (CN) encoding α-tryptase. The determination of HαT is being discussed as an important biomarker to be included in risk assessment models and future diagnostic algorithms for patients with mastocytosis and anaphylaxis. Due to the complex genetic structure at the human tryptase locus, genetic testing for tryptase gene composition is presently notably limited and infrequently pursued. This study aimed to develop, optimise and validate a multiplex droplet digital PCR (ddPCR) assay that can reliably quantify α- and β-tryptase encoding sequences in a single reaction. To optimise the ddPCR conditions and establish an amplitude-based multiplex ddPCR assay, additional primers and probes, a thermal gradient with varying annealing temperatures, different primers/probe concentrations, and various initial DNA quantities were tested. Results obtained from all 114 samples analysed using multiplex ddPCR were identical to those obtained through the use of original duplex assays. Utilizing this multiplex ddPCR assay, in contrast to conducting distinct duplex ddPCRs, presents noteworthy benefits for tryptase genotyping. These advantages encompass a substantial threefold decrease in material costs and considerable time savings. Consequently, this approach exhibits high suitability and particularly captures interest for routine clinical implementation.
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Affiliation(s)
- Manca Svetina
- University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
- Biotechnical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Julij Šelb
- University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Jonathan J Lyons
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, USA
| | - Peter Korošec
- University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
- Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Matija Rijavec
- University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia.
- Biotechnical Faculty, University of Ljubljana, Ljubljana, Slovenia.
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Pardanani A, Tefferi A, Al-Kali A, Patnaik M, Hogan WJ, Begna K, Elliott MA, Khera N, Palmer JM, Gangat N, Orazi A, Kelemen K, Reichard KK, Chen D. Reappraisal of mast cell leukemia based on a single institution review of 16 cases: Mast cell morphology determines clinical outcome. Am J Hematol 2024; 99:E1-E4. [PMID: 37688525 DOI: 10.1002/ajh.27089] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 08/23/2023] [Indexed: 09/11/2023]
Abstract
Cytologic abnormalities of atypical mast cells in mastocytosis. The mature mast cells have oval-shaped nuclei, cytoplasmic hypogranulation and spindle-shaped cytology. or well-differentiated displaying a round nucleus with condensed chromatin, and abundant dense cytoplasmic granulations. Immature mast cells include promastocytes and metachromatic blast-like forms.
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Affiliation(s)
| | - Ayalew Tefferi
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Aref Al-Kali
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mrinal Patnaik
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - William J Hogan
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kebede Begna
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Nandita Khera
- Division of Hematology/Oncology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Jeanne M Palmer
- Division of Hematology/Oncology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Naseema Gangat
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Attilio Orazi
- Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Katalin Kelemen
- Division of Hematopathology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Dong Chen
- Division of Hematopathology, Mayo Clinic, Rochester, Minnesota, USA
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Conner JE, Steinberg JA. Approach to Idiopathic Anaphylaxis in Adolescents. Med Clin North Am 2024; 108:123-155. [PMID: 37951646 DOI: 10.1016/j.mcna.2023.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
Anaphylaxis is a potentially-life threatening condition. Adolescents are particularly vulnerable due to increased risk-taking behaviors, poor disease management, and minimized perception of risk. Although most anaphylaxis can be attributed to food, drug, or venom allergy via a detailed history and confirmatory studies, in nearly 1 in 5 cases, the cause may not be obvious. Clinical differentials including rare allergens, cofactors, mast-cell disorders, and mimic disorders can increase the likelihood of discovering of the cause of anaphylaxis.
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Affiliation(s)
- Jeanne E Conner
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Medical College of Wisconsin, 9000 West Wisconsin Avenue. B440, Milwaukee, WI 53226, USA
| | - Joshua A Steinberg
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Medical College of Wisconsin, 9000 West Wisconsin Avenue. B440, Milwaukee, WI 53226, USA; Section of Allergy, Department of Medicine, Clement J. Zablocki Veterans' Affairs Medical Center, 5000 West National Avenue, 1AN, Milwaukee, WI 53295, USA.
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Docquier M, Nouspikel T, Blouin JL, Abramowicz M, Seebach JD, Spoerl D. Detection of TPSAB1 copy number variation for the diagnosis of hereditary alpha-tryptasemia by quantitative PCR. Clin Exp Allergy 2024; 54:82-85. [PMID: 37853996 DOI: 10.1111/cea.14413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/13/2023] [Accepted: 09/27/2023] [Indexed: 10/20/2023]
Affiliation(s)
- M Docquier
- iGE3 (Institute of Genetics and Genomics of Geneva) Genomics platform, University of Geneva, Geneva, Switzerland
| | - T Nouspikel
- Genetic Medicine, Geneva University Hospitals, Geneva, Switzerland
- Department of Genetic Medicine and Development, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - J L Blouin
- Genetic Medicine, Geneva University Hospitals, Geneva, Switzerland
- Department of Genetic Medicine and Development, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - M Abramowicz
- Genetic Medicine, Geneva University Hospitals, Geneva, Switzerland
- Department of Genetic Medicine and Development, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - J D Seebach
- Division of Clinical Immunology and Allergy, Department of Medicine, University Hospital and Faculty of Medicine, Geneva, Switzerland
| | - D Spoerl
- Division of Clinical Immunology and Allergy, Department of Medicine, University Hospital and Faculty of Medicine, Geneva, Switzerland
- Division of Laboratory Medicine, Department of Diagnostics, Geneva University Hospitals, Geneva, Switzerland
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10
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Parke L, Fomsgaard Kjaer H, Sivertsen Garvik O, Halken S, Broesby-Olsen S, Bindslev-Jensen C, Mortz CG. Real-Life Adherence to Venom Immunotherapy and Adrenaline Autoinjector. Int Arch Allergy Immunol 2023; 185:228-236. [PMID: 38052182 DOI: 10.1159/000535294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 11/13/2023] [Indexed: 12/07/2023] Open
Abstract
INTRODUCTION Venom immunotherapy (VIT) and adrenaline autoinjector (AAI) are important therapies in venom anaphylaxis. Adherence to VIT and AAI in patients with venom allergy has been evaluated in a few studies; however, solid data are lacking. This study aimed to evaluate VIT and AAI retrieval rates in patients with venom allergy with a special focus on adherence to treatment. Adherence was compared to subcutaneous immunotherapy (SCIT) with inhalant allergens. METHODS This was a retrospective study among patients registered for allergen immunotherapy at the Allergy Center, Odense University Hospital, Denmark, from January 1, 2010, to December 31, 2014. Data on purchased immunotherapy and AAI were obtained from the Danish National Health Service Prescription Database. Multivariable logistic regression was used to analyze if allergen, age, sex, mastocytosis, and treatment site affected adherence. RESULTS The 3-year adherence to VIT was 92.4% (244/264) compared to 87.4% (215/246) in SCIT with inhalant allergens, and the 5-year adherence to VIT was 84.1% (222/264) compared to 74.8% (184/246) in SCIT with inhalant allergens (p = 0.045). Females treated with VIT were more adherent than males (p = 0.45 [3-year], p = 0.008 [5-year]), whereas allergen, age, mastocytosis, or treatment site did not significantly affect adherence. Only 28.6% of patients (12/42) purchased an AAI after premature termination of VIT. CONCLUSION In this register-based study, we found that the 3- and 5-year adherences to VIT and SCIT with inhalant allergens are at the upper end of the spectrum hitherto reported. Patients' 5-year adherence to VIT was higher than patients' 5-year adherence to SCIT with inhalant allergens. If VIT was prematurely terminated, less than 1/3 would have purchased an AAI.
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Affiliation(s)
- Louise Parke
- Department of Dermatology and Allergy Center, Odense Research Center for Anaphylaxis (ORCA), Odense University Hospital, Odense, Denmark
| | - Henrik Fomsgaard Kjaer
- Department of Dermatology and Allergy Center, Odense Research Center for Anaphylaxis (ORCA), Odense University Hospital, Odense, Denmark
| | - Olav Sivertsen Garvik
- Institute of Clinical Research, Center for Clinical Epidemiology, Odense University Hospital, and Research Unit of Clinical Epidemiology, University of Southern Denmark, Odense, Denmark
| | - Susanne Halken
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | | | - Carsten Bindslev-Jensen
- Department of Dermatology and Allergy Center, Odense Research Center for Anaphylaxis (ORCA), Odense University Hospital, Odense, Denmark
| | - Charlotte G Mortz
- Department of Dermatology and Allergy Center, Odense Research Center for Anaphylaxis (ORCA), Odense University Hospital, Odense, Denmark
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Zhu CK, Nguyen A, Prosty C, Gabrielli S, Mulé P, Netchiporouk E, Le M, Zhang X, Shand G, Baum S, Hakroush R, Greenberger S, Ollech A, Miedzybrodzki B, Ben-Shoshan M. Safety of COVID-19 mRNA vaccination and effects of SARS-CoV-2 infection in children and adults with mast cell disorders. Clin Exp Med 2023; 23:4937-4942. [PMID: 37837561 DOI: 10.1007/s10238-023-01213-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/30/2023] [Indexed: 10/16/2023]
Abstract
Mastocytosis is characterized by abnormal clonal mast cell proliferation. Given the paucity of data in patients with mastocytosis, it is crucial to assess the safety of COVID-19 vaccines in this population. We aimed to assess the risk of allergic reactions and the effect of COVID-19 infection among patients with mastocytosis. Participants were recruited from Canada and Israel between December 2021 and May 2022. Consenting participants were administered standardized questionnaires querying whether they were infected with COVID-19, if they received the first and second dose vaccines, and post-vaccination side effects including allergic reactions (urticaria/angioedema, current rash flaring, need for updosing medications, or respiratory symptoms) and common side effects including injection site reaction (ISR) and flu-like symptoms. Forty participants with mastocytosis were administered a standardized questionnaire (median age = 9, 59% male). Amongst all participants, 16 (39%) reported COVID-19 infection and most (75%) reported flu-like symptoms, 3 (19%) were asymptomatic, 1 suffered from shortness of breath/chest pain and 1 from facial flushing. Of the 25 participants who were eligible for vaccination (≥ 5 years old), 80% received a first-dose vaccine and 68% received a second-dose vaccine. Of those who received the first-dose vaccine, most (60%) remained asymptomatic, 20% developed flu-like symptoms, 20% had an ISR, and 1 patient had an allergic reaction (urticaria and swelling). Of those who received the second-dose vaccine, most (53%) were asymptomatic, and 1 had an allergic reaction. No significant difference was found between side effects of both vaccine doses. No reactions fulfilled the criteria for anaphylaxis in either dose. This study reveals that among patients with mastocytosis, COVID-19 vaccine and infection were well-tolerated in the majority of cases.
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Affiliation(s)
- Catherine K Zhu
- Faculty of Medicine, McGill University, 1001 Décarie Blvd, Montréal, QC, H4A 3J1, Canada.
| | - Alex Nguyen
- Faculty of Medicine, McGill University, 1001 Décarie Blvd, Montréal, QC, H4A 3J1, Canada
| | - Connor Prosty
- Faculty of Medicine, McGill University, 1001 Décarie Blvd, Montréal, QC, H4A 3J1, Canada
| | - Sofianne Gabrielli
- Faculty of Medicine, McGill University, 1001 Décarie Blvd, Montréal, QC, H4A 3J1, Canada
| | - Pasquale Mulé
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Centre, Montréal, QC, Canada
| | - Elena Netchiporouk
- Division of Dermatology, McGill University Health Centre, Montréal, QC, Canada
| | - Michelle Le
- Division of Dermatology, McGill University Health Centre, Montréal, QC, Canada
| | - Xun Zhang
- Centre for Outcome Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, QC, Canada
| | - Greg Shand
- Centre for Outcome Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, QC, Canada
| | - Sharon Baum
- Department of Dermatology, Chaim Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Reman Hakroush
- Pediatric Dermatology Service, Department of Dermatology, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv, Israel
| | - Shoshana Greenberger
- Pediatric Dermatology Service, Department of Dermatology, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv, Israel
| | - Ayelet Ollech
- Pediatric Dermatology Service, Department of Dermatology, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | | | - Moshe Ben-Shoshan
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Centre, Montréal, QC, Canada
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12
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Papadopoulou V, Barcena-Garcia C, Basset V, Schoumans J, de Leval L, Schaller M. Invariant finding of non-clonal bone marrow lymphocytosis, with increased B cell component, in indolent systemic mastocytosis. Int J Lab Hematol 2023; 45:1007-1010. [PMID: 37525322 DOI: 10.1111/ijlh.14140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 07/09/2023] [Indexed: 08/02/2023]
Affiliation(s)
- Vasiliki Papadopoulou
- Hematology Service, Department of Oncology, Lausanne University Hospital, Lausanne, Switzerland
| | - Carmen Barcena-Garcia
- Institute of Pathology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Valentin Basset
- Hematology Service, Department of Oncology, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Laurence de Leval
- Institute of Pathology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Muriel Schaller
- Hematology Service, Department of Oncology, Lausanne University Hospital, Lausanne, Switzerland
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13
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Francois F, Mauff BL, Waeckel L, de Chaisemartin L, Tabary T, Dumontet E, Lecron JC, Delamare B, Boumediene A, Chauvineau-Grenier A, Pescarmona R, Garnier L, Lambert C. Basal serum tryptase: A critical reconsideration of reference values. Allergy 2023; 78:3003-3006. [PMID: 37357803 DOI: 10.1111/all.15790] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 05/27/2023] [Accepted: 06/11/2023] [Indexed: 06/27/2023]
Affiliation(s)
- Fabien Francois
- Laboratoire d'Immunologie, Pôle de Biologie, CHU Saint-Étienne, Saint-Étienne, France
| | | | - Louis Waeckel
- Laboratoire d'Immunologie, Pôle de Biologie, CHU Saint-Étienne, Saint-Étienne, France
| | | | - Thierry Tabary
- Laboratoire d'Immunologie CHU Reims, Pôle de Biologie Territoriale, Reims, France
| | | | | | | | | | | | | | | | - Claude Lambert
- Laboratoire d'Immunologie, Pôle de Biologie, CHU Saint-Étienne, Saint-Étienne, France
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14
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Hernandez CL, Lynch DM, Golash AJ, Marquis K, Besz KM, Oxnard G, Rotow J, DeAngelo DJ, Castells M. Anaphylaxis and systemic mastocytosis controlled with KIT inhibitors in a patient with metastatic lung adenocarcinoma. Ann Allergy Asthma Immunol 2023; 131:668-670. [PMID: 37597693 DOI: 10.1016/j.anai.2023.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 08/21/2023]
Affiliation(s)
- Camellia L Hernandez
- Department of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Massachusetts.
| | - Donna-Marie Lynch
- Department of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Abby Jane Golash
- Department of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Kathleen Marquis
- Department of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Kylie Marie Besz
- Department of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Geoffrey Oxnard
- Department of Medical Oncology, Boston Medical Center, Boston, Massachusetts
| | - Julia Rotow
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Daniel J DeAngelo
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Mariana Castells
- Department of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Massachusetts
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15
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Vincent R, Webber L, Dunnill MGS. Clinician awareness of the risk of anaphylaxis in patients with cutaneous mastocytosis. Clin Exp Dermatol 2023; 48:1271-1272. [PMID: 37439147 DOI: 10.1093/ced/llad237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/02/2023] [Indexed: 07/14/2023]
Abstract
The risk of anaphylaxis in maculopapular cutaneous mastocytosis (otherwise known as urticaria pigmentosa) is thought to be approximately 15%. Our survey of British Association of Dermatologists members elicited 40 responses: in patients with normal tryptase levels, adrenaline autoinjectors were prescribed for 10% of adults and 12% of children, increasing to 28% and 30% in those with raised tryptase. Of the 40 respondents, 95% felt a guideline would be beneficial. Thus, we propose a call for a guideline to assist clinicians with management of anaphylaxis risk in such patients, given the rarity of this condition.
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Affiliation(s)
- Rosie Vincent
- Department of Dermatology, University Hospital Bristol and Weston NHS Foundation Trust, UK
| | - Lucy Webber
- Department of Dermatology, University Hospital Bristol and Weston NHS Foundation Trust, UK
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16
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Blank U, Pucillo C. Editorial: Advances in mast cell physiology and mast cell-driven diseases. Front Immunol 2023; 14:1303726. [PMID: 37928555 PMCID: PMC10622654 DOI: 10.3389/fimmu.2023.1303726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 10/05/2023] [Indexed: 11/07/2023] Open
Affiliation(s)
- Ulrich Blank
- Université Paris Cité, Centre de Recherche sur l’Inflammation, Institut National de la Santé et de la Recherche Médicale (INSERM) Unité Mixte de Recherche (UMR)1149, Centre National de la Recherche Scientifique (CNRS) Equipe Mixte de Recherche (EMR)-8252, Faculté de Médecine site Bichat, Paris, France
- Université Paris Cité, Laboratoire d’Excellence INFLAMEX, Paris, France
| | - Carlo Pucillo
- Department of Medicine, University of Udine, Udine, Italy
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17
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Karube K, Takeuchi K. Masqueraded mastocytosis with prominent crystal-storing histiocytic infiltration. Blood 2023; 142:1404. [PMID: 37856090 DOI: 10.1182/blood.2023021961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023] Open
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18
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Bocca-Tjeertes IFA, Boot AM, Brand HK, van Doormaal JJ, Oude Elberink HNG. Vertebral fracture in a 7-year-old boy with indolent systemic mastocytosis. J Allergy Clin Immunol Pract 2023; 11:3269-3271. [PMID: 37399946 DOI: 10.1016/j.jaip.2023.06.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 05/31/2023] [Accepted: 06/20/2023] [Indexed: 07/05/2023]
Affiliation(s)
- Inger F A Bocca-Tjeertes
- Department of Pediatrics, Subdivision of Pulmonology and Allergology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
| | - Annemieke M Boot
- Department of Pediatrics, Subdivision of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Hanne K Brand
- Department of Pediatric Pulmonology and Allergology, Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Jasper J van Doormaal
- Department of Internal Medicine, Division of Allergology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Hanneke N G Oude Elberink
- Department of Internal Medicine, Division of Allergology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Groningen Research Institute for Asthma and COPD, University of Groningen, Groningen, the Netherlands
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19
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Sarsik S, Soliman SH, Elhalaby RE. Unusual presentation of telangiectasia macularis eruptiva perstans at the site of healed herpes zoster; Wolf's isotopic response. Australas J Dermatol 2023; 64:e237-e240. [PMID: 37318879 DOI: 10.1111/ajd.14108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/29/2023] [Accepted: 06/03/2023] [Indexed: 06/17/2023]
Abstract
There are several reported cases of Wolf's isotopic response, including infections, cancers, inflammatory and immune-related disorders. It is interesting that the majority of these occurred after herpes zoster (HZ) had healed. In this article, we describe an unusual case of adult mastocytosis/telangiectasia macularis eruptiva perstans (TMEP) at the location of recovered HZ. Given that adult mastocytosis is thought to be caused by dysregulation of the mast cell growth factor receptor, the c-Kit proto-oncogene (CD117), and the fact that the varicella zoster virus-infected cutaneous lesions contain CD117-positive mast cells (CD117+MCs), we hypothesize that CD117+ MCs may be in charge of the local immunological response and cytokine release those results in TMEP after HZ.
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Affiliation(s)
- Sameh Sarsik
- Department of Dermatology and Venereology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Sarah H Soliman
- Department of Dermatology and Venereology, Faculty of Medicine, Tanta University, Tanta, Egypt
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20
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Carter MC, Park J, Vadas P, Worm M. Extrinsic and Intrinsic Modulators of Anaphylaxis. J Allergy Clin Immunol Pract 2023; 11:1998-2006. [PMID: 37230384 DOI: 10.1016/j.jaip.2023.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/09/2023] [Accepted: 05/10/2023] [Indexed: 05/27/2023]
Abstract
The severity of anaphylaxis is determined by many factors. The allergenic source as well as the age of the affected individual and the route of allergen exposure encompass the major contributors of the clinical outcome. Moreover, the severity can be modulated further by intrinsic and extrinsic factors. Among these, the genetic predisposition, certain comorbidities such as uncontrolled asthma, and hormonal fluctuations have been proposed as intrinsic and antihypertensive medications or physical activity as extrinsic factors. Recent advances have highlighted immunologic pathways that may exacerbate the response to allergens through receptors on mast cells, basophils, platelets, and other granulocytes. Atopy, platelet-activating factor acetylhydrolase deficiency, hereditary alpha tryptasemia, and clonal mast cell disorders are examples associated with genetic alterations that may predispose to severe anaphylaxis. Identifying risk factors that lower the threshold of reactivity or increase the severity of multisystem reactions is important in the management of this patient population.
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Affiliation(s)
- Melody C Carter
- Mast Cell Biology Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md.
| | - Jane Park
- Division of Clinical Immunology and Allergy, Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Peter Vadas
- Division of Clinical Immunology and Allergy, Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Margitta Worm
- Division of Allergy and Immunology, Department of Dermatology, Venerology and Allergy, Charité Universitätsmedizin Berlin, Berlin, Germany
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21
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Metcalfe DD. Targeted Therapy for the Predominant Form of Mastocytosis. NEJM Evid 2023; 2:EVIDe2300089. [PMID: 38320134 DOI: 10.1056/evide2300089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Mast cells are present in all vascularized tissues, often associated with blood vessels, glandular structures, and nerves, and they tend to be more numerous in tissues that interface with the external environment, including the skin and gastrointestinal tract. These mast cells are involved in both innate and acquired immunity, as well as in other biologic processes, including wound healing. Mast cell numbers within tissues are remarkably consistent, although mast cell numbers somewhat increase in association with inflammation. Human mast cells have two principal receptors that when stimulated, lead to cellular activation.
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Affiliation(s)
- Dean D Metcalfe
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
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22
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Patel N, Maric I. A rare case of well-differentiated systemic mastocytosis. Blood 2023; 141:2403. [PMID: 37166923 PMCID: PMC10356551 DOI: 10.1182/blood.2022019281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
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23
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Kennedy VE, Perkins C, Reiter A, Jawhar M, Lübke J, Kluin-Nelemans HC, Shomali W, Langford C, Abuel J, Hermine O, Niedoszytko M, Gorska A, Mital A, Bonadonna P, Zanotti R, Tanasi I, Mattsson M, Hagglund H, Triggiani M, Yavuz AS, Panse J, Christen D, Heizmann M, Shoumariyeh K, Müller S, Elena C, Malcovati L, Fiorelli N, Wortmann F, Vucinic V, Brockow K, Fokoloros C, Papageorgiou SG, Breynaert C, Bullens D, Doubek M, Ilerhaus A, Angelova-Fischer I, Solomianyi O, Várkonyi J, Sabato V, Rüfer A, Schug TD, Hermans MAW, Fortina AB, Caroppo F, Bumbea H, Gulen T, Hartmann K, Elberink HO, Schwaab J, Arock M, Valent P, Sperr WR, Gotlib J. Mast cell leukemia: clinical and molecular features and survival outcomes of patients in the ECNM Registry. Blood Adv 2023; 7:1713-1724. [PMID: 36094848 PMCID: PMC10182174 DOI: 10.1182/bloodadvances.2022008292] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/29/2022] [Accepted: 08/24/2022] [Indexed: 11/20/2022] Open
Abstract
Mast cell leukemia (MCL) is a rare subtype of systemic mastocytosis defined by ≥20% mast cells (MC) on a bone marrow aspirate. We evaluated 92 patients with MCL from the European Competence Network on Mastocytosis registry. Thirty-one (34%) patients had a diagnosis of MCL with an associated hematologic neoplasm (MCL-AHN). Chronic MCL (lack of C-findings) comprised 14% of patients, and only 4.5% had "leukemic MCL" (≥10% circulating MCs). KIT D816V was found in 62/85 (73%) evaluable patients; 9 (11%) individuals exhibited alternative KIT mutations, and no KIT variants were detected in 14 (17%) subjects. Ten evaluable patients (17%) had an abnormal karyotype and the poor-risk SRSF2, ASXL1, and RUNX1 (S/A/R) mutations were identified in 16/36 (44%) patients who underwent next-generation sequencing. Midostaurin was the most common therapy administered to 65% of patients and 45% as first-line therapy. The median overall survival (OS) was 1.6 years. In multivariate analysis (S/A/R mutations excluded owing to low event rates), a diagnosis of MCL-AHN (hazard ratio [HR], 4.7; 95% confidence interval [CI], 1.7-13.0; P = .001) and abnormal karyotype (HR, 5.6; 95% CI, 1.4-13.3; P = .02) were associated with inferior OS; KIT D816V positivity (HR, 0.33; 95% CI, 0.11-0.98; P = .04) and midostaurin treatment (HR, 0.32; 95% CI, 0.08-0.72; P = .008) were associated with superior OS. These data provide the most comprehensive snapshot of the clinicopathologic, molecular, and treatment landscape of MCL to date, and should help further inform subtyping and prognostication of MCL.
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Affiliation(s)
| | - Cecelia Perkins
- Stanford Cancer Institute/Stanford University School of Medicine, Stanford, CA
| | - Andreas Reiter
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Mohamad Jawhar
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Johannes Lübke
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | | | - William Shomali
- Stanford Cancer Institute/Stanford University School of Medicine, Stanford, CA
| | - Cheryl Langford
- Stanford Cancer Institute/Stanford University School of Medicine, Stanford, CA
| | - Justin Abuel
- Stanford Cancer Institute/Stanford University School of Medicine, Stanford, CA
| | - Olivier Hermine
- Imagine Institute Université de Paris, Sorbonne, INSERM U1163, Centre national de référence des mastocytoses, Hôpital Necker, Assistance publique hôpitaux de Paris, Paris, France
| | - Marek Niedoszytko
- Department of Allergology, Medical University of Gdansk, Gdańsk, Poland
| | - Aleksandra Gorska
- Department of Allergology, Medical University of Gdansk, Gdańsk, Poland
| | - Andrzej Mital
- Department of Hematology, Medical University of Gdansk, Gdańsk, Poland
| | - Patrizia Bonadonna
- Department of Medicine, Section of Hematology, Verona University Hospital, Verona, Italy
| | - Roberta Zanotti
- Department of Medicine, Section of Hematology, Verona University Hospital, Verona, Italy
| | - Ilaria Tanasi
- Department of Medicine, Section of Hematology, Verona University Hospital, Verona, Italy
| | - Mattias Mattsson
- Department of Hematology, Uppsala University Hospital and Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Hans Hagglund
- Department of Hematology, Uppsala University Hospital and Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Massimo Triggiani
- Division of Allergy and Clinical Immunology, University of Salerno, Salerno, Italy
| | - Akif Selim Yavuz
- Division of Hematology, Istanbul Medical School, University of Istanbul, Istanbul, Turkey
| | - Jens Panse
- Department of Oncology, Haematology, Haemostaseology and Stem Cell Transplantation, University Hospital RWTH Aachen, and Center for Integrated Oncology, Aachen, Bonn, Cologne, Düsseldorf, Aachen, Germany
| | - Deborah Christen
- Department of Oncology, Haematology, Haemostaseology and Stem Cell Transplantation, University Hospital RWTH Aachen, and Center for Integrated Oncology, Aachen, Bonn, Cologne, Düsseldorf, Aachen, Germany
| | - Marc Heizmann
- Division of Oncology, Haematology and Transfusion Medicine, Kantonsspital Aarau AG, University Clinic of Medicine, Aarau, Switzerland
| | - Khalid Shoumariyeh
- Department of Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg and German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Sabine Müller
- Department of Dermatology, Medical Center-University of Frieburg, Faculty of Medicine, University of Frieburg, Frieburg, Germany
| | - Chiara Elena
- Hematology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Luca Malcovati
- Hematology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Nicolas Fiorelli
- Hematology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Friederike Wortmann
- Klinik für Hämatologie und Onkologie, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | | | - Knut Brockow
- Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University of Munich, Munich, Germany
| | - Christos Fokoloros
- Mastocytosis Clinic, Allergy Unit, 2nd Department of Dermatology & Venereology, University of Athens, Attikon General University Hospital, Athens, Greece
| | - Sotirios G. Papageorgiou
- Mastocytosis Clinic, Allergy Unit, 2nd Department of Dermatology & Venereology, University of Athens, Attikon General University Hospital, Athens, Greece
- 2nd Propaedeutic Department of Internal Medicine and Research Institute, Hematology Unit, University of Athens, Attikon University Hospital, Athens, Greece
| | - Christine Breynaert
- KU Leuven Department of Microbiology, Immunology, and Transplantation, Allergy and Clinical Immunology Research Group and MASTeL, University Hospitals Leuven, Leuven, Belgium
| | - Dominique Bullens
- KU Leuven Department of Microbiology, Immunology, and Transplantation, Allergy and Clinical Immunology Research Group and MASTeL, University Hospitals Leuven, Leuven, Belgium
| | - Michael Doubek
- Brno University Hospital and Faculty of Medicine, Brno, Czechia
| | - Anja Ilerhaus
- Uniklinik Köln, Klinik für Dermatologie und Venerologie, Cologne, Germany
| | | | | | - Judit Várkonyi
- Department of Hematology, Semmelweis University, Budapest, Hungary
| | - Vito Sabato
- Department of Immunology, Allergy, and Rheumatology, Universiteit Antwerpen, Campus Drie Eiken, Antwerp, Belgium
| | - Axel Rüfer
- Luzerner Kantonsspital, Lucerne, Switzerland
| | | | - Maud A. W. Hermans
- Department of Internal Medicine, Section Allergy & Clinical Immunology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Anna Belloni Fortina
- Pediatric Dermatology, Internal Medicine, Azienda Ospedaliera, Università di Padov, Padua, Italy
| | - Francesca Caroppo
- Pediatric Dermatology, Internal Medicine, Azienda Ospedaliera, Università di Padov, Padua, Italy
| | - Horia Bumbea
- Department of Hematology, Carol Davila University of Medicine, Emergency University Hospital, Bucharest, Romania
| | - Theo Gulen
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital Huddinge, and Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Karin Hartmann
- Division of Allergy, Departments of Dermatology and Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Hanneke Oude Elberink
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Juliana Schwaab
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Michel Arock
- Laboratory of Hematology, Pitié-Salpêtrière Hospital, Paris, France
| | - Peter Valent
- Division of Hematology and Hemostaseology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
| | - Wolfgang R. Sperr
- Division of Hematology and Hemostaseology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
| | - Jason Gotlib
- Stanford Cancer Institute/Stanford University School of Medicine, Stanford, CA
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24
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Graf I, Herndlhofer S, Kundi M, Greiner G, Sperr M, Hadzijusufovic E, Valent P, Sperr WR. Incidence of symptomatic Covid-19 infections in patients with mastocytosis and chronic myeloid leukemia: A comparison with the general Austrian population. Eur J Haematol 2023; 110:67-76. [PMID: 36193973 PMCID: PMC9874474 DOI: 10.1111/ejh.13875] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/28/2022] [Accepted: 09/30/2022] [Indexed: 04/23/2023]
Abstract
BACKGROUND The SARS-COV-2 (Covid-19) pandemic has impacted the management of patients with hematologic disorders. In some entities, an increased risk for Covid-19 infections was reported, whereas others including chronic myeloid leukemia (CML) had a lower mortality. We have analyzed the prevalence of Covid-19 infections in patients with mastocytosis during the Covid-19 pandemic in comparison to data from CML patients and the general Austrian population. MATERIALS AND METHODS The prevalence of infections and PCR-proven Covid-19 infections was analyzed in 92 patients with mastocytosis. As controls, we used 113 patients with CML and the expected prevalence of Covid-19 in the general Austrian population. RESULTS In 25% of the patients with mastocytosis (23/92) signs and symptoms of infection, including fever (n = 11), dry cough (n = 10), sore throat (n = 12), pneumonia (n = 1), and dyspnea (n = 3) were recorded. Two (8.7%) of these symptomatic patients had a PCR-proven Covid-19 infection. Thus, the prevalence of Covid-19 infections in mastocytosis was 2.2%. The number of comorbidities, subtype of mastocytosis, regular exercise, smoking habits, age, or duration of disease at the time of interview did not differ significantly between patients with and without Covid-19 infections. In the CML cohort, 23.9% (27/113) of patients reported signs and symptoms of infection (fever, n = 8; dry cough, n = 17; sore throat, n = 11; dyspnea, n = 5). Six (22.2%) of the symptomatic patients had a PCR-proven Covid-19 infection. The prevalence of Covid-19 in all CML patients was 5.3%. The observed number of Covid-19 infections neither in mastocytosis nor in CML patients differed significantly from the expected number of Covid-19 infections in the Austrian population. CONCLUSIONS Our data show no significant difference in the prevalence of Covid-19 infections among patients with mastocytosis, CML, and the general Austrian population and thus, in mastocytosis, the risk of a Covid-19 infection was not increased compared to the general population.
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Affiliation(s)
- Irene Graf
- Division of Hematology and Hemostaseology, Department of Internal Medicine IMedical University of ViennaViennaAustria
- Ludwig Boltzmann Institute of Hematology and OncologyMedical University of ViennaViennaAustria
| | - Susanne Herndlhofer
- Division of Hematology and Hemostaseology, Department of Internal Medicine IMedical University of ViennaViennaAustria
- Ludwig Boltzmann Institute of Hematology and OncologyMedical University of ViennaViennaAustria
| | - Michael Kundi
- Institute of Environmental HealthMedical University of ViennaViennaAustria
| | - Georg Greiner
- Ihr Labor, Medical Diagnostic LaboratoriesViennaAustria
| | - Martina Sperr
- Division of Hematology and Hemostaseology, Department of Internal Medicine IMedical University of ViennaViennaAustria
| | - Emir Hadzijusufovic
- Division of Hematology and Hemostaseology, Department of Internal Medicine IMedical University of ViennaViennaAustria
- Ludwig Boltzmann Institute of Hematology and OncologyMedical University of ViennaViennaAustria
| | - Peter Valent
- Division of Hematology and Hemostaseology, Department of Internal Medicine IMedical University of ViennaViennaAustria
- Ludwig Boltzmann Institute of Hematology and OncologyMedical University of ViennaViennaAustria
| | - Wolfgang R. Sperr
- Division of Hematology and Hemostaseology, Department of Internal Medicine IMedical University of ViennaViennaAustria
- Ludwig Boltzmann Institute of Hematology and OncologyMedical University of ViennaViennaAustria
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25
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Gotlib J. Available and emerging therapies for bona fide advanced systemic mastocytosis and primary eosinophilic neoplasms. Hematology Am Soc Hematol Educ Program 2022; 2022:34-46. [PMID: 36485158 PMCID: PMC9821059 DOI: 10.1182/hematology.2022000368] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The historically poor prognosis of patients with advanced systemic mastocytosis (AdvSM) and primary eosinophilic neoplasms has shifted to increasingly favorable outcomes with the discovery of druggable targets. The multikinase/KIT inhibitor midostaurin and the highly selective KIT D816V inhibitor avapritinib can elicit marked improvements in measures of mast cell (MC) burden as well as reversion of MC-mediated organ damage (C-findings) and disease symptoms. With avapritinib, the achievement of molecular remission of KIT D816V and improved survival compared with historical therapy suggests a potential to affect disease natural history. BLU-263 and bezuclastinib are KIT D816V inhibitors currently being tested in trials of AdvSM. In the new World Health Organization and International Consensus Classifications, the category of "myeloid/lymphoid neoplasms with eosinophilia and tyrosine kinase (TK) gene fusions" is inclusive of rearrangements involving PDGFRA, PDGFRB, FGFR1, JAK2, FLT3, and ETV6::ABL1. While the successful outcomes with imatinib in FIP1L1::PDGFRA-positive cases and PDGFRB-rearranged neoplasms have become the "poster children" of these disorders, the responses of the other TK-driven neoplasms to small-molecule inhibitors are more variable. The selective FGFR inhibitor pemigatinib, approved in August 2022, is a promising therapy in aggressive FGFR1-driven diseases and highlights the role of such agents in bridging patients to allogeneic transplantation. This review summarizes the data for these approved and investigational agents and discusses open questions and future priorities regarding the management of these rare diseases.
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Affiliation(s)
- Jason Gotlib
- Division of Hematology, Stanford Cancer Institute/Stanford University School of Medicine, Stanford, CA
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Kirsch M, Stehle GT, Konantz M, Passweg J, Dirnhofer S, Meyer SC, Hartmann K. Presence of neoplastic mast cells in ascites in advanced systemic mastocytosis. J Allergy Clin Immunol Pract 2022; 10:3035-3038.e1. [PMID: 35872218 DOI: 10.1016/j.jaip.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/28/2022] [Accepted: 07/13/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Mark Kirsch
- Division of Internal Medicine, University Hospital Basel and University of Basel, Basel, Switzerland.
| | - Gregor T Stehle
- Division of Hematology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Martina Konantz
- Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Jakob Passweg
- Division of Hematology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Stefan Dirnhofer
- Department of Medical Genetics and Pathology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Sara C Meyer
- Division of Hematology, University Hospital Basel and University of Basel, Basel, Switzerland; Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Karin Hartmann
- Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland; Division of Allergy, Department of Dermatology, University Hospital Basel and University of Basel, Basel, Switzerland
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27
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Valent P, Hartmann K, Bonadonna P, Gülen T, Brockow K, Alvarez-Twose I, Hermine O, Niedoszytko M, Carter MC, Hoermann G, Butterfield JH, Lyons JJ, Sperr WR, Greiner G, Sotlar K, Kluin-Nelemans HC, Schwaab J, Lange M, George TI, Siebenhaar F, Broesby-Olsen S, Jawhar M, Nedoszytko B, Castells M, Orfao A, Gotlib J, Reiter A, Horny HP, Triggiani M, Arock M, Metcalfe DD, Akin C. Global Classification of Mast Cell Activation Disorders: An ICD-10-CM-Adjusted Proposal of the ECNM-AIM Consortium. J Allergy Clin Immunol Pract 2022; 10:1941-1950. [PMID: 35623575 DOI: 10.1016/j.jaip.2022.05.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/04/2022] [Accepted: 05/11/2022] [Indexed: 12/18/2022]
Abstract
Mast cell activation (MCA) is common and occurs in a number of pathologic conditions, including IgE-dependent and independent allergic reactions, atopic disorders, autoimmune processes, and mastocytosis. In a subset of patients, no underlying disease and no known trigger of MCA are found. When the symptoms are severe, systemic, and recurrent, and accompanied by a diagnostic increase in the serum tryptase level or other mast cell mediators, an MCA syndrome (MCAS) may be diagnosed. In these patients, the symptoms typically respond to drugs suppressing MCA, mediator production in mast cells, or mediator effects. In each case, diagnostic consensus criteria must be fulfilled to diagnose MCAS. In other patients, MCA may be local, less severe, or less acute, or may be suspected but not confirmed, so that the diagnostic criteria of MCAS are not fulfilled. In these patients, it may be difficult to prove MCA, for example, by measuring multiple mast cell mediators or basophil activation, the latter as a surrogate of IgE-dependent hypersensitivity. However, validated diagnostic criteria for implicating suspected MCA behind such conditions are lacking, even if some of these conditions have recently been assigned to an International Classification of Diseases-10-Clinical Modification code (ICD-10-CM). In this article, we discuss diagnostic features and criteria and propose a ICD-10-CM-adjusted classification for disorders associated with MCA, herein referred to as MCA disorders (MCADs), with special emphasis on the delineation between confirmed MCAS, MCAD not fulfilling MCAS criteria, and suspected MCAD that is not present. In addition, we discuss the discrimination between overt MCAD and predisposing conditions, such as atopic states, mastocytosis, and hereditary alpha tryptasemia.
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Affiliation(s)
- Peter Valent
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria; Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria.
| | - Karin Hartmann
- Division of Allergy, Department of Dermatology, University Hospital Basel and University of Basel, Basel, Switzerland; Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | | | - Theo Gülen
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital Huddinge, Stockholm, Sweden; Department of Medicine Solna, Division of Immunology and Allergy, Karolinska Institutet, Stockholm, Sweden
| | - Knut Brockow
- Department of Dermatology and Allergy Biederstein, Technical University of Munich, Munich, Germany
| | - Ivan Alvarez-Twose
- Instituto de Estudios de Mastocitosis de Castilla La Mancha (CLMast) and CIBERONC, Hospital Virgen del Valle, Toledo, Spain
| | - Olivier Hermine
- Service d'hématologie, Imagine Institute Université de Paris, Sorbonne, INSERM U1163, Centre national de référence des mastocytoses, Hôpital Necker, Assistance publiquehôpitaux de Paris, Paris, France
| | - Marek Niedoszytko
- Department of Allergology, Medical University of Gdansk, Gdansk, Poland
| | - Melody C Carter
- Mast Cell Biology Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Gregor Hoermann
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria; MLL Munich Leukemia Laboratory, Munich, Germany
| | | | - Jonathan J Lyons
- Translational Allergic Immunopathology Unit, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Wolfgang R Sperr
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria; Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
| | - Georg Greiner
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria; Department of Laboratory Medicine, Medical University of Vienna, and Ihr Labor, Vienna, Austria
| | - Karl Sotlar
- Institute of Pathology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Hanneke C Kluin-Nelemans
- Department of Haematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Juliana Schwaab
- Department of Hematology and Oncology, University Hospital Mannheim, Mannheim, Germany
| | - Magdalena Lange
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, Gdansk, Poland
| | - Tracy I George
- Department of Pathology, University of Utah, Salt Lake City, Utah
| | - Frank Siebenhaar
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt - Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Sigurd Broesby-Olsen
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark
| | - Mohamad Jawhar
- Department of Hematology and Oncology, University Hospital Mannheim, Mannheim, Germany
| | - Boguslaw Nedoszytko
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, Gdansk, Poland; Invicta Fertility and Reproductive Center, Molecular Laboratory, Sopot, Poland
| | - Mariana Castells
- Division of Allergy and Immunology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Alberto Orfao
- Servicio Central de Citometria, Centro de Investigacion del Cancer (IBMCC; CSIC/USAL), Instituto Biosanitario de Salamanca (IBSAL), CIBERONC and Department of Medicine, University of Salamanca, Salamanca, Spain
| | - Jason Gotlib
- Stanford Cancer Institute/Stanford University School of Medicine, Stanford, Calif
| | - Andreas Reiter
- Department of Hematology and Oncology, University Hospital Mannheim, Mannheim, Germany
| | - Hans-Peter Horny
- Institute of Pathology, Ludwig-Maximilians-University, Munich, Germany
| | - Massimo Triggiani
- Division of Allergy and Clinical Immunology, University of Salerno, Salerno, Italy
| | - Michel Arock
- Department of Hematological Biology, Pitié-Salpêtrière Hospital, Pierre et Marie Curie University (UPMC), Paris, France
| | - Dean D Metcalfe
- Mast Cell Biology Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Cem Akin
- Division of Allergy and Clinical Immunology, University of Michigan, Ann Arbor, Mich
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Fernandes AL, Mendonça M, Costa D, Freitas SC, Pereira SM. Anaesthesia in a parturient with systemic mastocytosis. Rev Esp Anestesiol Reanim (Engl Ed) 2022; 69:368-371. [PMID: 35760695 DOI: 10.1016/j.redare.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 12/27/2020] [Indexed: 06/15/2023]
Abstract
Mastocytosis is characterized by clonal expansion of mast cells, with abnormal accumulation in different organs. Perioperatively, numerous stimuli may lead to the release of vasoactive substances by mast cells. Parturients with systemic mastocytosis pose a challenge to the anesthesiologist: on one hand, the pain and stress of labor may lead to greater mast cell activation and, on the other, the administration of drugs that may possibly trigger the release of mast cell mediators. The authors describe a case of a 34-year-old pregnant woman with systemic mastocytosis who requests labor analgesia. An epidural analgesia was performed after induction of labor, after considering anesthetic particularities. The epidural procedure, labor and delivery were uneventful. A review of systemic mastocytosis is provided and its anesthetic considerations are discussed.
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Affiliation(s)
- A L Fernandes
- Hospital Central do Funchal, Department of Anesthesiology, Madeira, Portugal.
| | - M Mendonça
- Hospital Central do Funchal, Department of Anesthesiology, Madeira, Portugal
| | - D Costa
- Hospital Central do Funchal, Department of Anesthesiology, Madeira, Portugal
| | - S C Freitas
- Hospital Central do Funchal, Department of Anesthesiology, Madeira, Portugal
| | - S M Pereira
- Hospital Central do Funchal, Department of Anesthesiology, Madeira, Portugal
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29
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Awan SF, Schwartz LB, Maric I, Metcalfe DD, Carter MC. Acute increases in total serum tryptase unassociated with hemodynamic instability in diffuse cutaneous mastocytosis. Ann Allergy Asthma Immunol 2022; 129:249-252. [PMID: 35568301 DOI: 10.1016/j.anai.2022.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/13/2022] [Accepted: 04/27/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Seemal F Awan
- Mast Cell Biology Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland.
| | - Larry B Schwartz
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Irina Maric
- Hematology Section, Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Dean D Metcalfe
- Mast Cell Biology Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Melody C Carter
- Mast Cell Biology Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
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30
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Lazarinis N, Bossios A, Gülen T. COVID-19 vaccination in the setting of mastocytosis-Pfizer-BioNTech mRNA vaccine is safe and well tolerated. J Allergy Clin Immunol Pract 2022; 10:1377-1379. [PMID: 35123098 PMCID: PMC8810433 DOI: 10.1016/j.jaip.2022.01.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/04/2022] [Accepted: 01/17/2022] [Indexed: 01/09/2023]
Affiliation(s)
- Nikolaos Lazarinis
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital Huddinge, Stockholm, Sweden; Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Apostolos Bossios
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital Huddinge, Stockholm, Sweden; Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Theo Gülen
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital Huddinge, Stockholm, Sweden; Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden; Clinical Immunology and Allergy Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Mastocytosis Center Karolinska, Karolinska Institutet and Karolinska University, Hospital Huddinge, Stockholm, Sweden.
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31
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Ren HL, Yang YS, Sun JL. [Research progress of mast cell activation syndrome]. Zhonghua Yu Fang Yi Xue Za Zhi 2021; 55:1513-1517. [PMID: 34963253 DOI: 10.3760/cma.j.cn112150-20210728-00722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Mast cells are the main effector cells in allergic diseases. Allergic diseases are mostly a direct result of mast cell mediator release effects, while allergen activation is only one of many triggers for mast cell mediator secretion. Increased mast cell number, high mast cell reactivity, or both can lead to abnormal mast cell activation. Mast cell activated syndrome (MCAS) refers to a group or a"spectrum"of mediator-related, symptomatically similar diseases in which mast cells are stimulated by multiple factors. The symptoms and signs of mast cell disease overlap with allergic diseases, but the etiology is different, which requires clinical attention. This article summarizes the research progress on mast cell activation syndrome in recent years thus increase awareness of the differential diagnosis.
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Affiliation(s)
- H L Ren
- Department of Allergy, Beijing Electric Power Hospital of State Grid Company of China, Electric Power Teaching Hospital of Capital Medical University, Beijing 100073, China
| | - Y S Yang
- Department of Allergy, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - J L Sun
- Department of Allergy, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
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32
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Novak P, Giannetti MP, Weller E, Hamilton MJ, Castells M. Mast cell disorders are associated with decreased cerebral blood flow and small fiber neuropathy. Ann Allergy Asthma Immunol 2021; 128:299-306.e1. [PMID: 34648976 DOI: 10.1016/j.anai.2021.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/01/2021] [Accepted: 10/08/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Mast cell disorders including hereditary alpha tryptasemia (HαT) and idiopathic mast cell activation syndrome (MCAS) can be associated with neurologic symptoms such as orthostatic intolerance, pain, and cognitive impairment. The origin of these symptoms is not well understood. OBJECTIVE To characterize neurologic findings in patients with HαT and MCAS through objective measurements. METHODS Patients with a confirmed diagnosis of HαT or MCAS with neurologic symptoms were referred for standardized autonomic testing encompassing Valsalva maneuver, deep breathing, sudomotor and tilt tests with cerebral blood flow velocity (CBFv) determination, and skin biopsies for small fiber neuropathy (SFN). RESULTS There were 15 patients with HαT (age 44.4 ± 15.9 years), 16 with MCAS (34.4 ± 15.5), and 14 matched controls who were evaluated. Baseline serum tryptase level was increased in patients with HαT when compared with patients with MCAS (14.3 ± 2.5 ng/mL vs 3.8 ± 1.8; P <.001) and neurologic symptoms were similar between the 2 groups. When compared with controls, orthostatic CBFv was reduced in HαT (-24.2 ± 14.3%; P <.001) and MCAS (-20.8 ± 5.5%; P <.001). Reduced nerve fibers consistent with SFN were found in 80% of patients with HαT and 81% of those with MCAS. Mild-to-moderate dysautonomia was detected in all patients with HαT and MCAS when results of sympathetic, parasympathetic, and sudomotor tests were combined. CONCLUSION We provide evidence of reduced orthostatic CBFv and SFN associated with mild-to-moderate autonomic dysfunction in patients with HαT and MCAS. Our findings suggest that comprehensive autonomic testing may be helpful to explain neurologic symptoms and guide treatment in patients with HαT and MCAS.
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Affiliation(s)
- Peter Novak
- Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Matthew P Giannetti
- Harvard Medical School, Boston, Massachusetts; Division of Allergy and Clinical Immunology, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Emily Weller
- Division of Allergy and Clinical Immunology, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Matthew J Hamilton
- Harvard Medical School, Boston, Massachusetts; Division of Gastroenterology, Endoscopy, and Hepatology, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Mariana Castells
- Harvard Medical School, Boston, Massachusetts; Division of Allergy and Clinical Immunology, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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Makovoz A, Wang J, Oshegbo G, Park YH, Lyons JJ, Eisch AR, Scott LM, Reynolds JC, Ortega-Villa AM, Metcalfe DD, Komarow HD. Assessment of Osteoporosis and Fracture Risk in Mastocytosis Within a North American Cohort. J Allergy Clin Immunol Pract 2021; 9:4459-4467.e10. [PMID: 34403839 DOI: 10.1016/j.jaip.2021.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 07/28/2021] [Accepted: 08/01/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Systemic mastocytosis (SM), a clonal expansion of mast cells affecting multiple organs including the skeletal system, puts patients at risk for osteoporosis and fractures. Various aspects of skeletal disease in SM have been reported among European cohorts. OBJECTIVE To determine fracture prevalence and risk predictors in SM in a North American (NA) cohort and compare findings with studies of other populations. METHODS Fifty patients, aged 25-74 years, were grouped based on fracture type and history. Data collected included laboratory findings and radiographic markers such as serum tryptase, bone turnover markers, dual-energy x-ray absorptiometry images, and trabecular bone scores. We performed univariate and multivariate analyses of these findings. RESULTS Fracture history was found in 74% of patients. Significantly different median age, body mass index, dual-energy x-ray absorptiometry scores, and alkaline phosphatase levels were observed between fracture groups, consistent with French and Dutch studies. Significant findings included the difference in trabecular bone scores among fracture groups, the association between alkaline phosphatase and fracture type and occurrence, and the model for predicting fracture risk based on DXA spine T-scores, alkaline phosphatase, and age (81.3% accuracy and 77.1% sensitivity). CONCLUSIONS Our findings in an NA cohort are in overall agreement with those reported in European studies of skeletal disease and fracture risk for individuals with SM. We include an interactive calculator designed from a predictive model based on the NA cohort, which may be used for improved screening for fracture risk.
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Affiliation(s)
- Ayelet Makovoz
- Mast Cell Biology Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Jing Wang
- Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick, Md
| | - Gloria Oshegbo
- Office of Biomedical Translational Research Informatics, Clinical Center, National Institute of Health, Bethesda, Md
| | - Young Hwan Park
- Translational Allergic Immunopathology Unit, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Jonathan J Lyons
- Translational Allergic Immunopathology Unit, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - A Robin Eisch
- Mast Cell Biology Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Linda M Scott
- Mast Cell Biology Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - James C Reynolds
- Radiology and Imaging Sciences, Clinical Center, National Institute of Health, Bethesda, Md
| | - Ana M Ortega-Villa
- Biostatistics Research Branch, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Dean D Metcalfe
- Mast Cell Biology Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Hirsh D Komarow
- Mast Cell Biology Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md.
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34
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De Puysseleyr LP, Ebo DG, Elst J, Faber MA, Poorten MLVD, Van Gasse AL, Bridts CH, Mertens C, Van Houdt M, Hagendorens MM, Verlinden A, Vermeulen K, Maes MB, Berneman ZN, Sabato V. Diagnosis of Primary Mast Cell Disorders in Anaphylaxis: Value of KIT D816V in Peripheral Blood. J Allergy Clin Immunol Pract 2021; 9:3176-3187.e3. [PMID: 33975032 DOI: 10.1016/j.jaip.2021.04.062] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/30/2021] [Accepted: 04/13/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Anaphylaxis is frequent in patients suffering from primary mast cell disorders (PMCDs). In patients without mastocytosis in the skin (MIS) and a baseline serum tryptase (bST) less than 30 ng/mL, the diagnosis of PMCD is challenging. In these patients, detection of the KIT D816V mutation in peripheral blood (PB) has been suggested as screening tool for a PMCD. OBJECTIVE In this study, we investigated whether KIT D816V in PB can contribute to the decision to perform a bone marrow (BM) biopsy in patients with anaphylaxis without MIS and a bST less than 30 ng/mL. METHODS We selected 74 patients with severe anaphylaxis without MIS and a bST less than 30 ng/mL. All underwent a BM biopsy. KIT D816V mutation was quantified in both PB and BM using digital droplet polymerase chain reaction (ddPCR). RESULTS Diagnosis of a PMCD was established in 40 patients (54%). Median bST for patients with and without PMCD was, respectively, 9.5 ng/mL (range 4.2-27 ng/mL) and 4.9 ng/mL (range 2.2-20.3 ng/mL) (P <.001). KIT D816V in PB was detected in 16 out of 40 (40%) patients with PMCD. KIT D816V in BM was detected in 22 out of 40 (55%) patients with PMCD. CONCLUSIONS In patients without MIS and a bST less than < 30 ng/mL who experience anaphylaxis, determination of KIT D816V mutation in PB is of limited help in deciding when to proceed to a BM biopsy. Therefore, KIT D816V in PB mutation analysis should be interpreted together with scoring tools to make a better assessment in identifying patients who should undergo BM biopsy.
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Affiliation(s)
- Leander P De Puysseleyr
- Faculty of Medicine and Health Sciences, Department of Immunology, Allergology, and Rheumatology and the Infla-Med Centre of Excellence University of Antwerp; and Department of Immunology, Allergology, and Rheumatology, Antwerp University Hospital, Antwerp, Belgium
| | - Didier G Ebo
- Faculty of Medicine and Health Sciences, Department of Immunology, Allergology, and Rheumatology and the Infla-Med Centre of Excellence University of Antwerp; and Department of Immunology, Allergology, and Rheumatology, Antwerp University Hospital, Antwerp, Belgium; Department of Immunology and Allergology, AZ Jan Palfijn Gent, Ghent, Belgium.
| | - Jessy Elst
- Faculty of Medicine and Health Sciences, Department of Immunology, Allergology, and Rheumatology and the Infla-Med Centre of Excellence University of Antwerp; and Department of Immunology, Allergology, and Rheumatology, Antwerp University Hospital, Antwerp, Belgium
| | - Margaretha A Faber
- Faculty of Medicine and Health Sciences, Department of Immunology, Allergology, and Rheumatology and the Infla-Med Centre of Excellence University of Antwerp; and Department of Immunology, Allergology, and Rheumatology, Antwerp University Hospital, Antwerp, Belgium
| | - Marie-Line van der Poorten
- Faculty of Medicine and Health Sciences, Department of Immunology, Allergology, and Rheumatology and the Infla-Med Centre of Excellence University of Antwerp; and Department of Immunology, Allergology, and Rheumatology, Antwerp University Hospital, Antwerp, Belgium; Faculty of Medicine and Health Sciences, Department of Paediatrics and the Infla-Med Centre of Excellence, University of Antwerp and Department of Paediatrics, Antwerp University Hospital, Antwerp, Belgium
| | - Athina L Van Gasse
- Faculty of Medicine and Health Sciences, Department of Immunology, Allergology, and Rheumatology and the Infla-Med Centre of Excellence University of Antwerp; and Department of Immunology, Allergology, and Rheumatology, Antwerp University Hospital, Antwerp, Belgium; Faculty of Medicine and Health Sciences, Department of Paediatrics and the Infla-Med Centre of Excellence, University of Antwerp and Department of Paediatrics, Antwerp University Hospital, Antwerp, Belgium
| | - Chris H Bridts
- Faculty of Medicine and Health Sciences, Department of Immunology, Allergology, and Rheumatology and the Infla-Med Centre of Excellence University of Antwerp; and Department of Immunology, Allergology, and Rheumatology, Antwerp University Hospital, Antwerp, Belgium
| | - Christel Mertens
- Faculty of Medicine and Health Sciences, Department of Immunology, Allergology, and Rheumatology and the Infla-Med Centre of Excellence University of Antwerp; and Department of Immunology, Allergology, and Rheumatology, Antwerp University Hospital, Antwerp, Belgium
| | - Michel Van Houdt
- Faculty of Medicine and Health Sciences, Department of Immunology, Allergology, and Rheumatology and the Infla-Med Centre of Excellence University of Antwerp; and Department of Immunology, Allergology, and Rheumatology, Antwerp University Hospital, Antwerp, Belgium
| | - Margo M Hagendorens
- Faculty of Medicine and Health Sciences, Department of Immunology, Allergology, and Rheumatology and the Infla-Med Centre of Excellence University of Antwerp; and Department of Immunology, Allergology, and Rheumatology, Antwerp University Hospital, Antwerp, Belgium; Faculty of Medicine and Health Sciences, Department of Paediatrics and the Infla-Med Centre of Excellence, University of Antwerp and Department of Paediatrics, Antwerp University Hospital, Antwerp, Belgium
| | - Anke Verlinden
- Department of Haematology, Antwerp University Hospital, Edegem, Belgium
| | - Katrien Vermeulen
- Department of Clinical Biology, Antwerp University Hospital, Edegem, Belgium
| | - Marie-Berthe Maes
- Department of Clinical Biology, Antwerp University Hospital, Edegem, Belgium
| | - Zwi N Berneman
- Department of Haematology, Antwerp University Hospital, Edegem, Belgium
| | - Vito Sabato
- Faculty of Medicine and Health Sciences, Department of Immunology, Allergology, and Rheumatology and the Infla-Med Centre of Excellence University of Antwerp; and Department of Immunology, Allergology, and Rheumatology, Antwerp University Hospital, Antwerp, Belgium; Department of Immunology and Allergology, AZ Jan Palfijn Gent, Ghent, Belgium
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Azenha Rama T, Álvarez-Twose I. Delving Into COVID-19 Vaccination-Induced Anaphylaxis: Are mRNA Vaccines Safe in Mast Cell Disorders? J Investig Allergol Clin Immunol 2021; 31:193-195. [PMID: 33574015 DOI: 10.18176/jiaci.0680] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023] Open
Affiliation(s)
- T Azenha Rama
- Serviço de Imunoalergologia, Centro Hospitalar Universitário São João, Porto, Portugal
- Serviço de Imunologia, Faculdade de Medicina da Universidade do Porto, Portugal
| | - I Álvarez-Twose
- Instituto de Estudios de Mastocitosis de Castilla La Mancha, Hospital Virgen del Valle, Toledo, Spain
- Spanish Network on Mastocytosis (REMA), Spain
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36
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Vitte J, Sabato V, Tacquard C, Garvey LH, Michel M, Mertes PM, Ebo DG, Schwartz LB, Castells MC. Use and Interpretation of Acute and Baseline Tryptase in Perioperative Hypersensitivity and Anaphylaxis. J Allergy Clin Immunol Pract 2021; 9:2994-3005. [PMID: 33746087 DOI: 10.1016/j.jaip.2021.03.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/05/2021] [Accepted: 03/11/2021] [Indexed: 12/18/2022]
Abstract
Paired acute and baseline serum or plasma tryptase sampling and determination have recently been included as a mechanistic approach in the diagnostic and management guidelines of perioperative immediate hypersensitivity and anaphylaxis. The timing of this paired sampling is clearly defined in international consensus statements, with the optimal window for acute tryptase sampling between 30 minutes and 2 hours after the initiation of symptoms, whereas baseline tryptase should be measured in a sample collected before the event (preop) or at least 24 hours after all signs and symptoms have resolved. A transient elevation of the acute tryptase level greater than [2 + (1.2 × baseline tryptase level)] supports the involvement and activation of mast cells. Here, we provide the clinical, pathophysiological, and technical rationale for the procedure and interpretation of paired acute and baseline tryptase. Clinical examples, up-to-date knowledge of hereditary α-tryptasemia as a frequent cause of baseline tryptase of 7 μg/L and higher, mastocytosis, other clonal myeloid disorders, cardiovascular or renal failure, and technical improvements resulting in continued lowering of the 95th percentile value are discussed. Clues for improved management of perioperative immediate hypersensitivity and anaphylaxis include (1) sustained dissemination and implementation of updated guidelines; (2) preoperative sample storage for deferred analysis; (3) referral for thorough allergy investigation, screening for mast cell-related disorders, and recommendations for future anesthetic procedures; and (4) sustained collaboration between anesthesiologists, immunologists, and allergists.
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Affiliation(s)
- Joana Vitte
- Aix-Marseille Univ, IRD, APHM, MEPHI, Marseille, France; IHU Méditerranée Infection, Marseille, France; IDESP, INSERM UMR UA11, University of Montpellier, Montpellier, France
| | - Vito Sabato
- Faculty of Medicine and Health Sciences, Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium; Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium; AZ Jan Palfijn Gent, Department of Immunology and Allergology, Ghent, Belgium
| | - Charles Tacquard
- Nouvel Hôpital Civil, hôpitaux universitaires de Strasbourg, service d'anesthésie-réanimation chirurgicale, 1, place de l'Hôpital, Strasbourg, France
| | - Lene H Garvey
- Allergy Clinic, Department of Dermatology and Allergy, Gentofte Hospital, Gentofte, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Moïse Michel
- Aix-Marseille Univ, IRD, APHM, MEPHI, Marseille, France; IHU Méditerranée Infection, Marseille, France; Laboratoire d'Immunologie, CHU de Nîmes, Nîmes, France
| | - Paul-Michel Mertes
- Nouvel Hôpital Civil, hôpitaux universitaires de Strasbourg, service d'anesthésie-réanimation chirurgicale, 1, place de l'Hôpital, Strasbourg, France
| | - Didier G Ebo
- Faculty of Medicine and Health Sciences, Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium; Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium; AZ Jan Palfijn Gent, Department of Immunology and Allergology, Ghent, Belgium
| | - Lawrence B Schwartz
- Department of Internal Medicine, Division of Rheumatology, Allergy & Immunology, Virginia Commonwealth University, Richmond, Va
| | - Mariana C Castells
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
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Sanusi SY, Hallett KB. Cutaneous Mastocytosis in a Pediatric Dental Patient: Multidisciplinary Approach to Oral Management. J Dent Child (Chic) 2021; 88:62-65. [PMID: 33875055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Mastocytosis is a heterogeneous disease of bone marrow origin, characterized by local or diffuse increased growth and accumulation of clonal mast cells in the skin and/or in internal organs. The skin is the organ most frequently involved, but others may be affected as well. The purpose of this article is to present the oral management of a child with urticaria pigmentosa/maculopapulous cutaneous mastocytosis requiring dental treatment under general anesthesia. The multidisciplinary team approach involving the relevant medical specialists is discussed to emphasize the significance of coordinated patient management.
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Affiliation(s)
- Sarliza Y Sanusi
- Dr. Sanusi is a lecturer, Unit of Paediatric Dentistry, School of Dental Sciences, Universiti Sains Malaysia, Kelantan, Malaysia;,
| | - Kerrod B Hallett
- Dr. Hallett is a clinical associate professor, Melbourne Dental School, University of Melbourne, Victoria, Australia
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Affiliation(s)
- Hannah Lee
- Department of Internal Medicine, University of Colorado School of Medicine, 12801 E. 17 Ave L18-8400, Aurora, CO 80045, USA
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Smiljkovic D, Kiss R, Lupinek C, Hoermann G, Greiner G, Witzeneder N, Krajnik G, Trautinger F, Vrtala S, Mittermann I, Kundi M, Jilma B, Valenta R, Sperr WR, Valent P. Microarray-Based Detection of Allergen-Reactive IgE in Patients with Mastocytosis. J Allergy Clin Immunol Pract 2020; 8:2761-2768.e16. [PMID: 32348913 DOI: 10.1016/j.jaip.2020.04.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 04/03/2020] [Accepted: 04/11/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Because of a high risk to develop fatal anaphylaxis, early detection of immunoglobulin E (IgE)-dependent allergy is of particular importance in patients with mastocytosis. OBJECTIVE We examined whether microarray-based screening for allergen-reactive IgE (allergen-chip) is a sensitive and robust approach to detect specific IgE in patients with mastocytosis. METHODS Sera for 42 patients were analyzed, including 4 with cutaneous mastocytosis, 2 with mastocytosis in the skin, and 36 with systemic mastocytosis. In addition, sera from an age- and sex-matched control cohort (n = 42) were analyzed. RESULTS In 15 of 42 patients with mastocytosis (35.7%), specific IgE was detected by allergen-chip profiling. Ves v 5 and Bet v 1 were the most frequently detected allergens (Ves v 5: 16.7% of patients; Bet v 1: 11.9% of patients). Allergen reactivity was confirmed by demonstrating upregulation of CD203c on blood basophils upon exposure to the respective allergen(s) in these patients. Specific IgE was identified by chip studies in 11 of 26 patients with mastocytosis with mediator-related symptoms (42.3%) and in 4 of 14 patients with mastocytosis without symptoms (28.6%). In the cohort with known allergy, 9 of 9 patients (100%) had a positive allergen-chip result. In patients with mastocytosis without a known allergy (n = 31), the chip identified 6 positive cases (19.5%). The prevalence of chip-positive patients was slightly lower in the mastocytosis group (35.7%) compared with age- and sex-matched controls (40.5%). CONCLUSIONS Although specific IgE may not be detectable in all sensitized patients with mastocytosis, allergy chip-profiling is a reliable screening approach for the identification of patients with mastocytosis suffering from IgE-dependent allergies.
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Affiliation(s)
- Dubravka Smiljkovic
- Department of Internal Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Renata Kiss
- Department of Pathophysiology and Allergy Research, Division of Immunopathology, Center for Pathophysiology, Immunology and Infectiology, Medical University of Vienna, Vienna, Austria
| | - Christian Lupinek
- Department of Pathophysiology and Allergy Research, Division of Immunopathology, Center for Pathophysiology, Immunology and Infectiology, Medical University of Vienna, Vienna, Austria
| | - Gregor Hoermann
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria; Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria; Central Institute of Medical and Chemical Laboratory Diagnostics, University Hospital Innsbruck, Innsbruck, Austria
| | - Georg Greiner
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria; Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
| | - Nadine Witzeneder
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Gerhard Krajnik
- Department of Internal Medicine I, University Hospital St. Poelten, St. Poelten, Austria
| | - Franz Trautinger
- Department of Dermatology, University Hospital St. Poelten, St. Poelten, Austria
| | - Susanne Vrtala
- Department of Pathophysiology and Allergy Research, Division of Immunopathology, Center for Pathophysiology, Immunology and Infectiology, Medical University of Vienna, Vienna, Austria
| | - Irene Mittermann
- Department of Pathophysiology and Allergy Research, Division of Immunopathology, Center for Pathophysiology, Immunology and Infectiology, Medical University of Vienna, Vienna, Austria
| | - Michael Kundi
- Institute of Environmental Health of the Medical University of Vienna, Vienna, Austria
| | - Bernd Jilma
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Rudolf Valenta
- Department of Pathophysiology and Allergy Research, Division of Immunopathology, Center for Pathophysiology, Immunology and Infectiology, Medical University of Vienna, Vienna, Austria; NRC Institute of Immunology FMBA of Russia, Moscow, Russia; Laboratory for Immunopathology, Department of Clinical Immunology and Allergy, Sechenov First Moscow State Medical University, Moscow, Russia; Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Wolfgang R Sperr
- Department of Internal Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Vienna, Austria; Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria.
| | - Peter Valent
- Department of Internal Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Vienna, Austria; Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria.
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Cohen Engler A, Confino Cohen R, Mekori Y. [HEREDITARY ALPHA TRYPTASEMIA - NEW DIAGNOSIS, FAMILIAR SYMPTOMS]. Harefuah 2020; 159:253-255. [PMID: 32307961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Mast cells are mostly known for their role in allergic reactions, as well as their involvement in diseases such as mast cell activation syndrome and systemic mastocytosis. One of the secreted enzymes during the allergic reaction and mast cell degranulation is tryptase. Recently, a new syndrome, namely - hereditary alpha tryptasemia, has been defined, originating from multiple copies of TPSAB1, the alpha-tryptase encoding gene. This syndrome has characteristic symptoms as well as biochemical and genetic markers. In this article we describe the first case of alpha tryptasemia diagnosed in Israel with emphasis on the typical symptoms and the biochemical and genetic workup needed to establish the diagnosis, as well as appropriate treatment.
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Affiliation(s)
- Anat Cohen Engler
- Allergy and Clinical Immunology Unit, Meir General Hospital, Kfar-Saba, Israel
| | - Ronit Confino Cohen
- Allergy and Clinical Immunology Unit, Meir General Hospital, Kfar-Saba, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yosef Mekori
- Allergy and Clinical Immunology Unit, Meir General Hospital, Kfar-Saba, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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41
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Sirufo MM, Suppa M, Ginaldi L, De Martinis M. Does Allergy Break Bones? Osteoporosis and Its Connection to Allergy. Int J Mol Sci 2020; 21:E712. [PMID: 31973226 PMCID: PMC7037724 DOI: 10.3390/ijms21030712] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 01/11/2020] [Accepted: 01/16/2020] [Indexed: 12/13/2022] Open
Abstract
: Osteoporosis and allergic diseases are important causes of morbidity, and traditionally their coexistence has been attributed to causality, to independent processes, and they were considered unrelated. However, the increasing knowledge in the field of osteoimmunology and an increasing number of epidemiological and biological studies have provided support to a correlation between bone and allergy that share pathways, cells, cytokines and mediators. If the link between allergic pathology and bone alterations appears more subtle, there are conditions such as mastocytosis and hypereosinophilic or hyper-IgE syndromes characterized by the proliferation of cells or hyper-production of molecules that play a key role in allergies, in which this link is at least clinically more evident, and the diseases are accompanied by frank skeletal involvement, offering multiple speculation cues. The pathophysiological connection of allergy and osteoporosis is currently an intriguing area of research. The aim of this review is to summarize and bring together the current knowledge and pursue an opportunity to stimulate further investigation.
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Affiliation(s)
- Maria Maddalena Sirufo
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (M.M.S.); (L.G.)
- Allergy and Clinical Immunology Unit, Center for the diagnosis and treatment of Osteoporosis, AUSL 04 Teramo, 64100 Teramo, Italy
| | - Mariano Suppa
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, 1070 Brussels, Belgium;
| | - Lia Ginaldi
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (M.M.S.); (L.G.)
- Allergy and Clinical Immunology Unit, Center for the diagnosis and treatment of Osteoporosis, AUSL 04 Teramo, 64100 Teramo, Italy
| | - Massimo De Martinis
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (M.M.S.); (L.G.)
- Allergy and Clinical Immunology Unit, Center for the diagnosis and treatment of Osteoporosis, AUSL 04 Teramo, 64100 Teramo, Italy
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Caminati M, Olivieri E, Nalin F, Zanotti R, Senna G, Schiappoli M, Dama A, Bonadonna P. Timing of response and long term efficacy of Omalizumab in non-clonal Mast Cell Activation Syndrome: A case series. Eur J Intern Med 2020; 71:104-106. [PMID: 31735545 DOI: 10.1016/j.ejim.2019.11.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 11/08/2019] [Indexed: 01/23/2023]
Affiliation(s)
- Marco Caminati
- Department of Medicine, University of Verona, Verona, Italy; Asthma Center and Allergy Unit, Verona University Hospital, Verona, Italy.
| | - Elisa Olivieri
- Asthma Center and Allergy Unit, Verona University Hospital, Verona, Italy
| | - Francesca Nalin
- Department of Medicine, Specialization Course in Allergy and Clinical Immunology, University of Verona, Verona, Italy
| | - Roberta Zanotti
- Department of Medicine, Haematology Unit, Verona University Hospital, Verona, Italy
| | - Gianenrico Senna
- Asthma Center and Allergy Unit, Verona University Hospital, Verona, Italy
| | - Michele Schiappoli
- Asthma Center and Allergy Unit, Verona University Hospital, Verona, Italy
| | - Annarita Dama
- Asthma Center and Allergy Unit, Verona University Hospital, Verona, Italy
| | - Patrizia Bonadonna
- Asthma Center and Allergy Unit, Verona University Hospital, Verona, Italy
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43
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Barete S. A useful add-on international prognostic score for mastocytosis? Lancet Haematol 2019; 6:e604-e605. [PMID: 31676323 DOI: 10.1016/s2352-3026(19)30212-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 08/19/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Stéphane Barete
- Centre de Référence des Mastocytoses (CEREMAST), Hôpital Pitié-Salpêtrière, Filière maladies rares en immunologie-hématologie (MaRIH), Paris, France; AP-HP, Hôpital Pitié-Salpêtrière, Unité fonctionnelle de Dermatologie, Sorbonne Université, UPMC Paris-6, 75013 Paris, France.
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44
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Hay JK, Larson VS. Lomustine (CCNU) and prednisone chemotherapy for high-grade completely excised canine mast cell tumors. Can Vet J 2019; 60:1326-1330. [PMID: 31814640 PMCID: PMC6855235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The efficacy and toxicity of lomustine and prednisone for treating high-grade completely excised mast cell tumors (MCTs) was evaluated in a retrospective study of 15 dogs. Dogs were treated with lomustine (CCNU) at 70 mg/m2 every 4 weeks and prednisone at 0.5 to 1 mg/kg body weight PO daily. Eight dogs had treatment failures due to recurrence at the site of the initial surgery (2/15), de novo cutaneous MCT (4/15), or metastatic disease (2/15). The median overall survival time was 904 days, with 9 dogs alive at 1 year and 6 dogs alive after 2 years. All but 2 of the dogs had toxicity throughout their treatment protocol, with neutropenia (67%) and elevations in ALT (60%) being the most common; however, no dogs required hospitalization. The protocol was overall well-tolerated and lomustine/prednisone should be considered in the adjunctive treatment of high-grade mast cell tumors.
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Affiliation(s)
- Jennifer K Hay
- CARE Centre, 7140 12 Street SE, Calgary, Alberta T2H 2Y4
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45
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Rossignol J, Polivka L, Maouche-Chrétien L, Frenzel L, Dubreuil P, Hermine O. Recent advances in the understanding and therapeutic management of mastocytosis. F1000Res 2019; 8:F1000 Faculty Rev-1961. [PMID: 31824655 PMCID: PMC6880274 DOI: 10.12688/f1000research.19463.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/13/2019] [Indexed: 12/20/2022] Open
Abstract
Mastocytosis is a rare disease due to the abnormal accumulation of mast cells in various tissues. Its clinical presentation is heterogeneous depending on mast cell infiltration and mediators release. In some cases, it is associated with hematological malignancies. Prognosis varies from very good with a life expectancy similar to the general population in indolent forms of the disease to a survival time of just a few months in mast cell leukemia. Although in most cases a somatic KIT D816V mutation is found in tumor mast cells, the physiopathology of the disease is not yet fully understood. Additional germline and somatic mutations may explain this heterogeneity. Treatments aim at blocking effect of mast cell mediators, reducing mast cell activation and tumor burden. New drugs mainly directed against the tyrosine kinase activity of KIT have dramatically changed the quality of life and prognosis of mast cell diseases. Present and future therapeutic strategies are discussed in this review.
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Affiliation(s)
- Julien Rossignol
- French Reference Center for Mastocytosis (CEREMAST), Necker Children's Hospital, APHP, Paris, France
| | - Laura Polivka
- Department of Hematology, Gustave Roussy Institute, Paris-Saclay University, Villejuif, France
| | | | - Laurent Frenzel
- Department of Dermatology, Necker Children's Hospital, APHP, Paris, France
| | - Patrice Dubreuil
- Department of Hematology, Necker Children's Hospital, APHP, Paris, France
| | - Olivier Hermine
- Centre de Recherche en Cancérologie de Marseille, Inserm U1068, Marseille, France
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46
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Akin C, Weiler C. Toward a Unified Database Registry in Mastocytosis. J Allergy Clin Immunol Pract 2019; 7:88. [PMID: 30598186 DOI: 10.1016/j.jaip.2018.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 11/01/2018] [Indexed: 06/09/2023]
Affiliation(s)
- Cem Akin
- Department of Internal Medicine, Division of Allergy and Immunology, University of Michigan, Ann Arbor, Mich.
| | - Catherine Weiler
- Department of Internal Medicine, Division of Allergy, Mayo Clinic, Rochester, Minn
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47
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Carter MC, Metcalfe DD, Matito A, Escribano L, Butterfield JH, Schwartz LB, Bonadonna P, Zanotti R, Triggiani M, Castells M, Brockow K. Adverse reactions to drugs and biologics in patients with clonal mast cell disorders: A Work Group Report of the Mast Cells Disorder Committee, American Academy of Allergy, Asthma & Immunology. J Allergy Clin Immunol 2018; 143:880-893. [PMID: 30528617 DOI: 10.1016/j.jaci.2018.10.063] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 09/06/2018] [Accepted: 10/09/2018] [Indexed: 12/27/2022]
Abstract
Providers caring for patients with mastocytosis are tasked with the decision to consider therapeutic options. This can come with some trepidation because information available in the public domain lists numerous mast cell (MC) activators based on data that do not discriminate between primates, rodents, and MC lines; do not consider dosage; and do not take into account previous exposure and resultant clinical findings. This being said, there is support in the literature for an enhanced MC response in some patients with mastocytosis and in cases in which there is a greater incidence of adverse reactions associated with certain antigens, such as venoms and drugs. Thus this report provides a comprehensive guide for those providers who must decide on therapeutic options in the management of patients with clonal MC disease.
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Affiliation(s)
- Melody C Carter
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md.
| | - Dean D Metcalfe
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Almudena Matito
- Instituto de Estudios de Mastocitosis de Castilla-La Mancha (CLMast), Hospital Virgen del Valle, Toledo, Spain; Spanish Network on Mastocytois (REMA), Toledo, Spain
| | - Luis Escribano
- Servicio General de Citometría, Centro de Investigación del Cáncer/IBMCC (USAL/CSIC) and Departamento de Medicina, Universidad de Salamanca and IBSAL, Salamanca, Spain; Spanish Network on Mastocytois (REMA), Toledo, Spain
| | - Joseph H Butterfield
- Division of Allergic Diseases and the Program for Mast Cell and Eosinophil Disorders, Mayo Clinic, Rochester, Minn
| | - Lawrence B Schwartz
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, Va
| | - Patrizia Bonadonna
- Allergy Unit, Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy; Multidisplinary Outpatients Clinic for Mastocytosis (GISM), Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Roberta Zanotti
- Multidisplinary Outpatients Clinic for Mastocytosis (GISM), Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy; Department of Medicine, Haematology Unit, Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Massimo Triggiani
- Division of Allergy and Clinical Immunology, University of Salerno, Salerno, Italy
| | - Mariana Castells
- Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Knut Brockow
- Department of Dermatology and Allergy Biederstein, Technical University of Munich, Munich, Germany
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Arock M. A new therapeutic advance for symptomatic systemic mastocytosis? Lancet 2017; 389:576-578. [PMID: 28069280 DOI: 10.1016/s0140-6736(16)31655-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 09/05/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Michel Arock
- Molecular and Cellular Oncology, LBPA CNRS UMR 8113, Ecole Normale Supérieure de Cachan, 94235-Cachan CEDEX, and Clinical Hematology Laboratory, Pitié-Salpêtrière Hospital, Paris, France.
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Abstract
Disorders of mast cell activation can be classified as primary (mastocytosis), secondary (reactive) or idiopathic. This article discusses how to recognise and approach the diagnosis of patients suspected to have symptoms of abnormal mast cell activation. Given the highly varied and often complex symptomatology of such patients, we advocate applying a logical step-wise approach to investigating these patients to ensure the correct diagnosis is made. Treatments of mast cell activation disorders are discussed, dividing them into those that ameliorate the effects of mast cell mediators and those that act to stabilise the mast cell.
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Affiliation(s)
- Hannah Cookson
- St John's Institute of Dermatology, Guys and St Thomas's Hospitals, London, UK
| | - Clive Grattan
- St John's Institute of Dermatology, Guys and St Thomas's Hospitals, London, UK
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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