S.C. Farmacia e U.Ma.C.A, IRCCS Istituto Tumori Giovanni Paolo II , Bari, Italy.
Anatomo-Pathology Department, IRCCS Istituto Tumori "Giovanni Paolo II" , Bari, Italy.
Expert Opin Pharmacother. 2020 Jun;21(9):1059-1069. doi: 10.1080/14656566.2020.1744566. Epub 2020 Mar 25.
Mast cell leukemia (MCL) is one of the most aggressive forms of Systemic Mastocytosis (SM), a complex family of rare diseases, for which standard therapies are very few. MCL represents only <1% cases of SM and this is the reason why there are no specific clinical trials to better explore this disease. As a consequence, MCL is treated and grouped within other forms of SM, being all KIT-driven diseases; however, its KIT dysregulation leads to uncontrolled activation of mast cells (MCs), which correlates with forms of myeloid acute leukemia (AML).
Different therapeutic approaches can be followed in the treatment of MCL. The authors look at both symptomatic therapies along with other approaches including targeted therapy. Further, the authors provide their expert opinion.
In the scenario of mast cell leukemia treatment, the key approach to achieve clinical results is, more than other similar pathologies, personalizing the therapy. It could be interesting or desirable to introduce for instance KIT mutant forms as minor criteria for the diagnosis of advanced SM, considering the small patient population with MCL and the relatively large panel of activating mutations for KIT and other important proteins involved in MCs' regulation.
肥大细胞白血病(MCL)是系统性肥大细胞增多症(SM)中最具侵袭性的形式之一,SM 是一组罕见疾病,标准疗法非常有限。MCL 仅占 SM 的<1%,这就是为什么没有专门的临床试验来更好地研究这种疾病的原因。因此,MCL 被归类为其他形式的 SM 进行治疗,因为所有这些疾病都由 KIT 驱动;然而,其 KIT 失调导致肥大细胞(MC)不受控制地激活,这与髓系急性白血病(AML)的形式相关。
在 MCL 的治疗中,可以采用不同的治疗方法。作者不仅关注对症治疗,还关注其他方法,包括靶向治疗。此外,作者提供了他们的专业意见。
在肥大细胞白血病的治疗方案中,实现临床疗效的关键方法是,比其他类似的病理情况更个性化地治疗疾病。考虑到 MCL 患者人数较少,且 KIT 和其他参与 MC 调节的重要蛋白的激活突变种类繁多,将 KIT 突变形式纳入高级 SM 的诊断次要标准可能是有趣的或值得考虑的。