Serum tryptase monitoring in indolent systemic mastocytosis: association with disease features and patient outcome

PLoS One. 2013 Oct 14;8(10):e76116. doi: 10.1371/journal.pone.0076116. eCollection 2013.

Abstract

Background: Serum baseline tryptase (sBT) is a minor diagnostic criterion for systemic mastocytosis (SM) of undetermined prognostic impact. We monitored sBT levels in indolent SM (ISM) patients and investigated its utility for predicting disease behaviour and outcome.

Methods: In total 74 adult ISM patients who were followed for ≥48 months and received no cytoreductive therapy were retrospectively studied. Patients were classified according to the pattern of evolution of sBT observed.

Results: Overall 16/74 (22%) cases had decreasing sBT levels, 48 (65%) patients showed increasing sBT levels and 10 (13%) patients showed a fluctuating pattern. Patients with significantly increasing sBT (sBT slope ≥0.15) after 48 months of follow-up showed a slightly greater rate of development of diffuse bone sclerosis (13% vs. 2%) and hepatomegaly plus splenomegaly (16% vs. 5%), as well as a significantly greater frequency of multilineage vs. mast cells (MC)-restricted KIT mutation (p = 0.01) together with a greater frequency of cases with progression of ISM to smouldering and aggressive SM (p = 0.03), and a shorter progression-free survival (p = 0.03).

Conclusions: Monitoring of sBT in ISM patients is closely associated with poor prognosis disease features as well as with disease progression, pointing out the need for a closer follow-up in ISM patients with progressively increasing sBT values.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Decision Trees
  • Demography
  • Disease Progression*
  • Disease-Free Survival
  • Female
  • Follow-Up Studies
  • Humans
  • Mast Cells / metabolism
  • Mastocytosis, Systemic / blood*
  • Mastocytosis, Systemic / enzymology*
  • Mastocytosis, Systemic / pathology
  • Multivariate Analysis
  • Mutation
  • Proto-Oncogene Proteins c-kit / genetics
  • Treatment Outcome
  • Tryptases / blood*

Substances

  • Proto-Oncogene Proteins c-kit
  • Tryptases

Grants and funding

This work was supported by grants from the Fondo de Investigaciones Sanitarias (FIS) of the Ministerio de Ciencia e Innovación of Spain (RETICS RD06/0020/0035-FEDER and PS09/00032); Fundación Sociosanitaria de Castilla-La Mancha (FISCAM 2007/36, FISCAM 2010/008 and G-2010/C-002); Instituto de Salud Carlos III of the Ministerio de Economía y Competitividad of Spain (PI11/02399); Junta de Castilla y León (SAN/103/2011); Fundación Ramón Areces; Fundación Española de Mastocitosis (FEM 2010); Hospital Virgen de la Salud Biobank (BioB-HVS) supported by grant of RETICS RD09/0076/00074, (Toledo, Spain). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.