title: Cladribine therapy for systemic mastocytosis.
abstract: Patients with systemic mastocytosis (SM) can suffer from disabling symptoms related to mast cell mediator release or mast cell infiltration, requiring mast cell eradication. In the present absence of any curative therapy, a recent case report describing the efficacy of cladribine showed promising results. In a pilot study, the efficacy of cladribine (0.10-0.13 mg/kg in a 2-hour infusion, days 1-5; repeated at 4-8 weeks until 6 cycles) was studied. Ten patients with SM with severe symptoms were treated. Four patients were classified as having indolent or smoldering mastocytosis, 3 as having aggressive systemic mastocytosis, and 3 as having SM with an accompanying hematologic malignancy. Nine patients received 6 courses, 1 patient stopped because of toxicodermia. All responded concerning signs, symptoms, and mast cell parameters (serum tryptase and urinary histamine metabolite excretion), although none achieved a complete remission. Prolonged follow-up is required, as response is ongoing in most cases. One patient relapsed within 11 months and showed a second response. Side effects were mainly related to bone marrow suppression. Single-agent cladribine is an effective and relatively safe treatment for severe systemic mastocytosis. The optimal dose and schedule need to be explored.
authors.affiliation: Department of Hematology, University Hospital Groningen, Hanzeplein 1, PO Box 30001, NL-9700 RB Groningen, The Netherlands. j.c.kluin.nelemans@int.azg.nl
authors.forename: Hanneke C
authors.initials: HC
authors.lastname: Kluin-Nelemans
authors.forename: J Marja
authors.initials: JM
authors.lastname: Oldhoff
authors.forename: Jasper J
authors.initials: JJ
authors.lastname: Van Doormaal
authors.forename: Jan W
authors.initials: JW
authors.lastname: Van 't Wout
authors.forename: Gregor
authors.initials: G
authors.lastname: Verhoef
authors.forename: Wim B J
authors.initials: WB
authors.lastname: Gerrits
authors.forename: O Aart
authors.initials: OA
authors.lastname: van Dobbenburgh
authors.forename: Suzanne G
authors.initials: SG
authors.lastname: Pasmans
authors.forename: Rob
authors.initials: R
authors.lastname: Fijnheer
mesh_terms: D000328:Adult; D000368:Aged; D000963:Antimetabolites / Q000009:adverse effects / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood / Q000652:urine; D017338:Cladribine / Q000009:adverse effects / Q000627:therapeutic use*; D003875:Drug Eruptions / Q000209:etiology; D005260:Female; D006801:Humans; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000150:complications; D008297:Male; D034721:Mastocytosis, Systemic / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000150:complications; D016896:Treatment Outcome
chemical_list: D000963:Antimetabolites; D015415:Biomarkers; D017338:Cladribine