A Comprehensive Review of Mastocytosis From Pathophysiology to Management Strategies
DOI:
https://doi.org/10.12775/JEHS.2024.66.015Keywords
Mastocytosis, Mast cells, Pathophysiology, Diagnosis, Management, TreatmentAbstract
Introduction: Mastocytosis is a rare hematologic neoplasm characterized by the abnormal proliferation and accumulation of mast cells in various tissues. Its clinical manifestations vary widely, ranging from cutaneous lesions to systemic involvement with potentially life-threatening symptoms. Understanding the pathophysiology, diagnosis, and management of mastocytosis is crucial for improving patient outcomes.
Aim of the Study: The aim of this study was to provide a comprehensive overview of mastocytosis, including its epidemiology, risk factors, pathophysiology, clinical manifestations, diagnostic approaches, and management strategies. By synthesizing current knowledge on mastocytosis, this study aims to enhance understanding of the disease and guide clinical practice.
Description of the State of Knowledge: Mastocytosis is classified into cutaneous and systemic forms, with various subtypes based on clinical and histopathological features. Diagnosis relies on a combination of clinical suspicion, serum tryptase levels, histological examination of bone marrow biopsies, and genetic testing. Management strategies include symptomatic treatment, avoidance of triggers, and targeted therapies such as monoclonal antibodies and tyrosine kinase inhibitors. Advanced forms may require cytoreductive therapy or allogeneic hematopoietic stem cell transplantation (alloHSCT).
Conclusions: Despite advancements in diagnosis and treatment, achieving lasting remission in mastocytosis remains challenging, especially in advanced cases. Further research into the molecular mechanisms underlying the disease and the development of novel therapeutic modalities are needed to improve patient outcomes and quality of life.
References
Maric, I., & Sun, X. (2019). Advances in diagnosis of mastocytosis and hypereosinophilic syndrome☆.. Seminars in hematology, 56 1, 22-29 . https://doi.org/10.1053/j.seminhematol.2018.05.005.
Rothe, Marti Jill et al. “The mast cell in health and disease.” Journal of the American Academy of Dermatology 23 4 Pt 1 (1990): 615-24. https://doi.org/10.1007/978-1-4939-1568-2_7
Debruin, Erin J. et al. “Mast cells in human health and disease.” Methods in molecular biology 1220 (2015): 93-119. https://doi.org/10.1007/978-1-4939-1568-2_7
Butterfield, Joseph H. et al. “Mast Cell Mediators of Significance in Clinical Practice in Mastocytosis.” Immunology and allergy clinics of North America 38 3 (2018): 397-410. DOI:https://doi.org/10.1016/j.iac.2018.04.011
Kola, E., Memini, J., Kola, I., Nakuci, D., Ekladous, J., Cipi, D., & Dervishi, M. (2020). Cutaneous Mastocytosis in a 61-year-old Female from a Dermatological and Histopathological Perspective. , 2, 01-06. https://doi.org/10.36811/ijdsc.2020.110004.
Statkevych, O., & Sviatenko, T. (2022). Mastocytosis. General concepts, view on patient management, examples of clinical course of the disease. CHILD`S HEALTH. https://doi.org/10.22141/2224-0551.17.2.2022.1502.
Le, M., Miedzybrodzki, B., Olynych, T., Chapdelaine, H., & Ben-Shoshan, M. (2017). Natural history and treatment of cutaneous and systemic mastocytosis. Postgraduate Medicine, 129, 896 - 901. https://doi.org/10.1080/00325481.2017.1364124.
Pardanani, A. (2016). Systemic mastocytosis: evolving lessons from large patient registry datasets. American Journal of Hematology, 91. https://doi.org/10.1002/ajh.24395.
Mahendraraj, Krishnaraj et al. “Malignant mastocytosis: a rare and diverse disease—demographics and clinical outcomes for 349 patients from the Surveillance, Epidemiology, and End Results (SEER) database (1973-2010).” Journal of The American College of Surgeons 219 (2014): n. pag, https://doi.org/10.1016/j.jamcollsurg.2014.07.833
Yazal Erdem, Arzu MD*; Özyörük, Derya MD*; Emir, Suna MD†; Çakmakçi, Selma MD*; Güleç Ceylan, Gülay MD‡; Toyran, Müge MD§; Civelek, Ersoy MD§; Dibek Misirlioğlu, Emine MD§. Clinical and Demographic Characteristics of Cutaneous Mastocytosis in Childhood: Single-center Experience. Journal of Pediatric Hematology/Oncology 44(1):p e227-e232, January 2022. | DOI: 10.1097/MPH.0000000000002196.
García-Erce, José Antonio et al. “[Systemic mastocytosis. Study of 14 cases].” Medicina clinica 111 13 (1998): 499-502 . PMID: 9859067.
Jawhar, M., Schwaab, J., Alvarez-Twose, I., Shoumariyeh, K., Naumann, N., Lübke, J., Perkins, C., Muñoz-González, J., Meggendorfer, M., Kennedy, V., Metzgeroth, G., Fabarius, A., Pfeifer, D., Sotlar, K., Horny, H., Bubnoff, N., Haferlach, T., Cross, N., Hofmann, W., Sperr, W., García-Montero, A., Valent, P., Gotlib, J., Órfão, A., & Reiter, A. (2019). MARS: Mutation-Adjusted Risk Score for Advanced Systemic Mastocytosis. Journal of Clinical Oncology, 37, 2846 - 2856. https://doi.org/10.1200/JCO.19.00640.
Hägglund, H., Sander, B., Gülen, T., Lindelöf, B., & Nilsson, G. (2014). Increased risk of malignant melanoma in patients with systemic mastocytosis?. Acta dermato-venereologica, 94 5, 583-4 . https://doi.org/10.2340/00015555-1788.
Azaña, J., Torrelo, A., & Matito, A. (2016). Update on Mastocytosis (Part 1): Pathophysiology, Clinical Features, and Diagnosis.. Actas dermo-sifiliograficas, 107 1, 5-14 . https://doi.org/10.1016/j.ad.2015.09.007.
Komi, D.E.A., Rambasek, T. & Wöhrl, S. Mastocytosis: from a Molecular Point of View. Clinic Rev Allerg Immunol 54, 397–411 (2018). https://doi.org/10.1007/s12016-017-8619-2
Tebbe, B., Stavropoulos, P., Krasagakis, K., & Orfanos, C. (1998). Cutaneous Mastocytosis in Adults. Dermatology, 197, 101 - 108. https://doi.org/10.1159/000017978.
Bulat, V., Mihić, L., Šitum, M., Buljan, M., Blajič, I., & Pušić, J. (2009). Most common clinical presentations of cutaneous mastocytosis.. Acta clinica Croatica, 48 1, 59-64 .
Inamadar, A., & Palit, A. (2006). Cutaneous mastocytosis: report of six cases.. Indian journal of dermatology, venereology and leprology, 72 1, 50-3 . https://doi.org/10.4103/0378-6323.19720.
Azaña, Jose Manuel et al. “Update on Mastocytosis (Part 2): Categories, Prognosis, and Treatment.” Actas dermo-sifiliograficas 107 1 (2016): 15-22, https://doi.org/10.1016/j.adengl.2015.11.002
Richard F. Horan et al. "Systemic mastocytosis: retrospective review of a decade's clinical experience at the Brigham and Women's Hospital.." The Journal of investigative dermatology, 96 3 (1991): 5S-13S; discussion 13S-14S . https://doi.org/10.1111/1523-1747.EP12468899.
T. Gülen et al. "Mastocytosis: the puzzling clinical spectrum and challenging diagnostic aspects of an enigmatic disease." Journal of Internal Medicine, 279 (2016): 211 - 228. https://doi.org/10.1111/joim.12410.
U. Müller et al. "The problem of anaphylaxis and mastocytosis." Current Allergy and Asthma Reports, 9 (2009): 64-70. https://doi.org/10.1007/S11882-009-0010-9.
Malisha R. Johnson et al. "Utility of the World Heath Organization classification criteria for the diagnosis of systemic mastocytosis in bone marrow." Modern Pathology, 22 (2009): 50-57. https://doi.org/10.1038/modpathol.2008.141.
A. Reiter et al. "New Developments in Diagnosis, Prognostication, and Treatment of Advanced Systemic Mastocytosis.." Blood (2020). https://doi.org/10.1182/blood.2019000932.
Hans-Peter Horny et al. "Diagnostic value of immunostaining for tryptase in patients with mastocytosis.." The American journal of surgical pathology, 22 9 (1998): 1132-40 . https://doi.org/10.1097/00000478-199809000-00013.
M. Hermans et al. "Management around invasive procedures in mastocytosis: An update.." Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology, 119 4 (2017): 304-309 . https://doi.org/10.1016/j.anai.2017.07.022.
M. Vaes et al. "Targeted Treatment Options in Mastocytosis." Frontiers in Medicine, 4 (2017). https://doi.org/10.3389/fmed.2017.00110.
Molina-Garrido MJ, Mora A, Guillén-Ponce C, et al. [Systemic mastocytosis: systematic review]. Anales de Medicina Interna (Madrid, Spain : 1984). 2008 Mar;25(3):134-140. DOI: 10.4321/s0212-71992008000300008. PMID: 18560682.
Alvarez-Twose, I., Matito, A., Sánchez-Muñoz, L., Morgado, J. M., & Escribano, L. (2014). Management of adult mastocytosis. Expert Opinion on Orphan Drugs, 2(4), 321–336. https://doi.org/10.1517/21678707.2014.884922
Quintás-Cardama, Alfonso et al. “Treatment of systemic mastocytosis with denileukin diftitox.” American Journal of Hematology 82 (2007): n. pag. https://doi.org/10.1002/ajh.21013
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Copyright (c) 2024 Magdalena Marchaj, Bartosz Basiaga, Klaudia Żądecka-Kobiałka, Anna Putra, Karolina Bednarz, Monika Nowicka-Jasińska, Paweł Frączyk, Sara Bieniek-Zając, Sebastian Baczkowski, Klaudia Krawiec
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