IntroductionSystemic mastocytosis (SM) is a myeloid neoplasm characterized by pathologic accumulation of mast cells (MCs) in one or more extracutaneous organs. 1,2 Indolent and aggressive variants of SM have been described. [1][2][3][4][5] In most patients, the transforming KIT mutation D816V is detectable independent of the category of SM. [6][7][8] Patients with indolent SM (ISM) have an excellent prognosis with normal or near-normal life expectancy. [1][2][3][4][5]9,10 In patients with aggressive SM (ASM) and mast cell leukemia (MCL), the prognosis is grave, [1][2][3][4][5]9,10 and responses to conventional drugs and most targeted drugs are poor. [1][2][3][4]9,[11][12][13][14][15] During the past few years, several attempts have been made to define new molecular targets in neoplastic MCs and to establish new treatment concepts for these patients. 16,17 Abnormal DNA methylation and histone-acetylation are frequently observed in various neoplasms and supposedly contribute to disease evolution and drug resistance. [18][19][20] In hematologic malignancies, epigenetic abnormalities have been reported in acute and chronic leukemias as well as in myelodysplastic syndromes (MDS). [21][22][23] Especially in patients with MDS, abnormal methylation of the genome has been described. 21,22 Correspondingly, epigenetically active drugs such as 5-azacytidine and 5-aza2Јdeoxycytidine (decitabine) reportedly act as antineoplastic agents in these patients. [23][24][25] More recent data suggest that demethylating agents also exert beneficial effects in patients in whom neoplastic cells exhibit myeloproliferative and myelodysplastic features, such as chronic myelomonocytic leukemia (CMML), and sometimes even in patients with advanced myeloproliferative neoplasms (MPN). 26,27 Advanced SM is a myeloid neoplasm that often presents with myeloproliferative features and sometimes with bone marrow (BM) dysplasia. [1][2][3][4][5] In addition, advanced SM may coexist with MDS (SM-MDS), CMML, or a JAK2-mutated MPN. 28 However, so far, no data on the effects of demethylating agents on neoplastic cells in advanced SM or SM-AHNMD are available. In addition, little is known about methylation patterns in neoplastic MCs. We explored the effects of 2 widely used demethylating agents, 5-azacytidine and decitabine, on growth and survival of neoplastic MCs, and examined the mechanism(s) of action of these drugs.
MethodsDrugs, monoclonal antibodies, and other reagents PKC412 (midostaurin) was kindly provided by Dr J. Roesel and Dr P. W. Manley (Novartis). 5-azacytidine, decitabine, recombinant human FASligand, and propidium iodide (PI) were purchased from Sigma-Aldrich, Submitted September 27, 2011; accepted February 29, 2012. Prepublished online as Blood First Edition paper, March 21, 2012; DOI 10.1182 DOI 10. /blood-2011 The online version of this article contains a data supplement.The publication costs of this article were defrayed in part by page charge payment. Therefore, and solely to indicate this fact, this article is hereby marked ''advertis...