This protocol applies to patients with indolent (ISM) or smoldering (SSM) systemic mastocytosis who experience recurrent hypotensive episodes — a presentation indicating that standard symptom-directed measures are insufficient and further escalation is warranted.
In indolent and smoldering systemic mastocytosis, management is primarily directed toward anaphylaxis prevention, symptom control, and osteoporosis treatment. Recurrent hypotension signals a failure of these goals and drives the need for a more targeted intervention strategy.
When recurrent hypotension persists despite earlier management, the protocol specifies a cytoreductive therapy as the designated next step. The specific agent or agents, selection criteria, and clinical sequencing are defined in the full structured protocol.
The complete regimen — agent selection, dosing parameters, and decision criteria — is available in the structured protocol below.
DOI: 10.1002/ajh.26962
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