Systemic mastocytosis in Croatia
Autori:
Ivan Krečak, Pavle Rončević, Marin Kursar, Marko Lucijanić, Davor Galušić, Stefan Mrđenović, Martina Morić Perić, Iva Ivanko, Hana Matijaca, Josipa Budimir, Sanja Jakelić, Ivana Karaman, Rajko Kušec
Sažetak
Cilj: Ciljevi ove studije bili su identificirati bolesnike sa sistemskom mastocitozom (SM) u Republici Hrvatskoj (RH) i analizirati njihove kliničke karakteristike. Ispitanici i metode: Retrospektivno su iz osam hematoloških centara u RH identificirani bolesnici sa SM. Analizirane su kliničke karakteristike, te načini i ishodi liječenja ovih bolesnika. Rezultati: Uključeno je 20 bolesnika, medijan dobi bio je 40,5 godina (raspon 24–77), a većinu su činile žene (n=12). Dominirali su bolesnici s indolentnom SM (ISM, n=11), dok je učestalost agresivne SM (ASM, n=4), „šuljajuće“ sistemske mastocitoze (SSM, n=3) i SM s pridruženom zloćudnom hematološkom bolešću (SM-AHND, n=2) bila manja. Gotovo su svi bolesnici imali kožni osip, a značajan broj njih i dispeptične smetnje, alergijsku dijatezu, bolove u kostima i osteoporozu. Antihistaminike je primala većina bolesnika, a citoredukciju 10 bolesnika (ISM=3, SSM=2,
ASM=4, SM-AHND=1). Većina bolesnika koja je zahtijevala citoreduktivno liječenje primala je interferon alfa-2a (2 ISM, 1 SSM i 3 ASM), dva steroida (1 ISM i 1 SM-AHND), te po jedan imatinib (SSM) i kladribin (ASM). Svi su bolesnici liječeni u prvoj liniji interferonom alfa-2a i kladribinom postigli parcijalnu remisiju, a dva bolesnika liječena imatinibom i steroidom bila su refraktorna na liječenje. Nije bilo prekida liječenja interferonom zbog nuspojava. Nakon medijana praćenja od 33 mjeseca preminulo je troje bolesnika, jedan s ASM i oba s SM-AHND. Medijan preživljenja bolesnika s ISM/SSM nije dostignut naspram bolesnika s ASM/SM-AHND, gdje je iznosio 105 mjeseci (p=0,009). Zaključak: Kliničke karakteristike i ishodi liječenja bolesnika sa SM u RH slični su onima iz velikih svjetskih centara. Najčešće korišten citoreduktivni lijek u RH bio je interferon alfa-2a koji se pokazao sigurnim i učinkovitim.
Summary
Aim: The aims of this study were to identify patients with systemic mastocytosis (SM) in Croatia and to analyze their clinical characteristics. Patients and methods: Patients with SM treated at eight hospitals in Croatia were retrospectively identified and their clinical characteristics, treatment patterns and outcomes were analyzed. Results: Twenty patients were included, median age was 40.5years (range 24-77), and most were females (n=12) . Patients with indolent SM (ISM, n=11) predominated, followed by aggressive SM (ASM, n=4), smoldering SM (SSM, n=3) and SM with an associated hematological neoplastic disorder (SM-AHND, n=2). Only one patient (with ASM) did not have cutaneous involvement, and a significant proportion of SM patients had dyspepsia, allergic diathesis, bone pains and osteoporosis. Antihistamines were administered in the majority of the patients, whereas ten patients needed cytoreductive treatment (ISM, n=3, SSM n=2, ASM, n=4, SM-AHND, n=1). Most SM patients in need for cytoreduction received interferon alpha-2a (two ISM, one SSM and three ASM), two received steroids (one ISM and one SM-AHND), one received imatinib (SSM) and the last patient was treated with cladribine (ASM). All patients treated first-line with interferons and cladribine achieved partial remission, whereas two patients treated with imatinib and steroid were refractory. None of the patients discontinued
interferon due to drug-related side-effects. After a median follow-up of 33 months, three patients died, one with ASM and two with SM-AHND.The median survival of ISM/SSM patients was higher than in ASM/SM-AHND patients in whom it was 105 months (p=0.009). Conclusion: Clinical characteristics and treatment outcomes of SM patients in Croatia are comparable to those from large international centers. The most commonly administered cytoreductive drug in Croatia was interferon alpha-2a which was shown to be safe and effective.
