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Open Access Highly Accessed Case report

Utility of hydroxyurea in mast cell activation syndrome

Lawrence B Afrin

Author Affiliations

Division of Hematology/Oncology, Medical University of South Carolina, Charleston, South Carolina, USA

Experimental Hematology & Oncology 2013, 2:28  doi:10.1186/2162-3619-2-28

Published: 9 October 2013


Mast cell activation syndrome (MCAS) is a relatively recently recognized cause of chronic multisystem polymorbidity of a generally inflammatory theme. Patients with MCAS often report migratory soft tissue and/or bone pain which frequently responds poorly to typical (narcotic and non-narcotic) analgesics as well as atypical analgesics such as antidepressants and anticonvulsants. Hydroxyurea (HU) is an oral ribonucleotide reductase inhibitor commonly used in the treatment of chronic myeloproliferative neoplasms and sickle cell anemia. HU has been used to treat systemic mastocytosis, sometimes effecting improvement in MC activation symptoms but not tumor burden, suggesting potential utility of the drug in MCAS, too. Reported here are five cases of successful use of relatively low-dose HU in MCAS to reduce symptoms including previously refractory soft tissue and/or bone pain. HU may be useful in treating mediator symptoms in MCAS, but further study is needed to define optimal dosing strategies and patient subpopulations most likely to benefit.

Mast cell activation disease; Mast cell activation syndrome; KIT mutations; Pain; Hydroxyurea