title: Successful treatment of mast cell activation syndrome with sunitinib.
abstract: Mast cell (MC) activation syndrome (MCAS) is a recently recognized, likely prevalent collection of heterogeneous illnesses of inappropriate MC activation with little to no MC neoplasia likely driven by heterogeneous patterns of constitutively activating mutations in MC regulatory elements including various tyrosine kinases (TKs, dominantly KIT). MCAS typically presents as chronic multisystem polymorbidity of generally inflammatory ± allergic theme. As with indolent systemic mastocytosis (SM), treatment of MCAS focuses more against MC mediators than MC neoplasia, but some cases prove refractory even to the TK inhibitor (TKI) imatinib reported useful both in uncommon SM cases not bearing SM's usual imatinib-resistant KIT-D816V mutation and in some cases of MCAS (which rarely bears KIT-D816V). Most allergy is principally a MC activation phenomenon and sunitinib is a multitargeted TKI shown helpful in controlling a murine model of oral allergy syndrome. We present the first report of use of sunitinib in life-threatening MCAS refractory to multiple agents including imatinib achieving immediate, complete, sustained, non-toxic remission suggesting a new option for treatment of aggressive MC disease.
authors.affiliation: Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Lawrence B
authors.initials: LB
authors.lastname: Afrin
authors.affiliation: Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Frank M
authors.initials: FM
authors.lastname: Cichocki
authors.affiliation: CARTI Hematology/Oncology, Little Rock, AR, USA.
authors.forename: Kamal
authors.initials: K
authors.lastname: Patel
authors.affiliation: Institute for Human Genetics, University of Bonn, Bonn, Germany.
authors.forename: Gerhard J
authors.initials: GJ
authors.lastname: Molderings
mesh_terms: D000328:Adult; D001706:Biopsy; D004386:Duodenum / Q000378:metabolism / Q000473:pathology; D005260:Female; D006801:Humans; D007211:Indoles / Q000627:therapeutic use*; D008407:Mast Cells / Q000378:metabolism / Q000473:pathology; D008415:Mastocytosis / Q000175:diagnosis / Q000188:drug therapy*; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use*; D011758:Pyrroles / Q000627:therapeutic use*; D000077210:Sunitinib; D016896:Treatment Outcome
chemical_list: D007211:Indoles; D047428:Protein Kinase Inhibitors; D011758:Pyrroles; D000077210:Sunitinib
keywords: mast cell; mast cell activation disease; mast cell activation syndrome; sunitinib; tyrosine kinase inhibitor