Case-control cohort study of patients' perceptions of disability in mastocytosis.
BACKGROUND
Indolent forms of mastocytosis account for more than 90% of all cases, but the types and type and severity of symptoms and their impact on the quality of life have not been well studied. We therefore performed a case-control cohort study to examine self-reported disability and impact of symptoms on the quality of life in patients with mastocytosis.


RESULTS
In 2004, 363 mastocytosis patients and 90 controls in France were asked to rate to their overall disability (OPA score) and the severity of 38 individual symptoms. The latter was used to calculate a composite score (AFIRMM score). Of the 363 respondents, 262 were part of an ongoing pathophysiological study so that the following data were available: World Health Organization classification, standard measures of physical and psychological disability, existence of the D816V KIT mutation, and serum tryptase level. The mean OPA and AFIRMM scores and the standard measures of disability indicated that most mastocytosis patients suffer from disabilities due to the disease. Surprisingly, the patient's measurable and perceived disabilities did not differ according to disease classification or presence or absence of the D816V KIT mutation or an elevated (> or = 20 ng/mL) serum tryptase level. Also, 32 of the 38 AFIRMM symptoms were more common in patients than controls, but there were not substantial differences according to disease classification, presence of the D816V mutation, or the serum tryptase level.


CONCLUSIONS
On the basis of these results and for the purposes of treatment, we propose that mastocytosis be first classified as aggressive or indolent and that indolent mastocytosis then be categorized according to the severity of patients' perceived symptoms and their impact on the quality of life. In addition, it appears that mastocytosis patients suffer from more symptoms and greater disability than previously thought, that mastocytosis may therefore be under-diagnosed, and that the symptoms of the indolent forms of mastocytosis might be due more to systemic release of mediators than mast cell burden.
Hermine
Olivier
O
Service de Dermatologie, Centre de référence sur la mastocytose, Hôpital Necker, Paris, France. hermine@necker.fr
Lortholary
Olivier
O
Leventhal
Phillip S
PS
Catteau
Adeline
A
Soppelsa
Frédérique
F
Baude
Cedric
C
Cohen-Akenine
Annick
A
Palmérini
Fabienne
F
Hanssens
Katia
K
Yang
Ying
Y
Sobol
Hagay
H
Fraytag
Sylvie
S
Ghez
David
D
Suarez
Felipe
F
Barete
Stéphane
S
Casassus
Philippe
P
Sans
Beatrice
B
Arock
Michel
M
Kinet
Jean Pierre
JP
Dubreuil
Patrice
P
Moussy
Alain
A
D016022:Case-Control Studies; D015331:Cohort Studies; D006233:Persons with Disabilities; D006801:Humans; D008415:Mastocytosis / Q000503:physiopathology* / Q000523:psychology; D009154:Mutation; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires