Epigenetic modulation and other options to improve outcome of stem cell transplantation in MDS.
Allogeneic stem cell transplantation can cure patients with myelodysplastic syndromes. However, more than 50% of the patients who underwent allogeneic stem cell transplantation have failed to benefit from this treatment approach either due to treatment-related mortality or to relapse. The introduction of toxicity or dose-reduced conditioning has significantly reduced the treatment-related mortality but did not affect the risk of relapse. New effective drugs, such as hypomethylating agents, histone-deacetylase inhibitors or lenalidomide, can be used alone or in combination to improve the pretransplant remission status before allogeneic stem cell transplantation or after transplantation to prevent relapse as maintenance or consolidation therapy. This review will focus on these new possibilities and give some perspectives as to how the results of allogeneic stem cell transplantation can be further improved.
Kröger
Nicolaus
N
Clinic for Stem Cell Transplantation, Medical University Hospital Hamburg-Eppendorf, Hamburg, Germany. nkroeger@uke.uni-hamburg.de
D002066:Busulfan / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000627:therapeutic use; D018450:Disease Progression; D004359:Drug Therapy, Combination; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D044127:Epigenesis, Genetic; D056572:Histone Deacetylase Inhibitors; D006801:Humans; D007951:Leukemia, Myeloid / Q000209:etiology; D009190:Myelodysplastic Syndromes / Q000188:drug therapy / Q000235:genetics* / Q000401:mortality / Q000601:surgery*; D012008:Recurrence; D012307:Risk Factors; D035781:Siblings; D033581:Stem Cell Transplantation; D014019:Tissue Donors; D016896:Treatment Outcome; D014916:Whole-Body Irradiation
D004791:Enzyme Inhibitors; D056572:Histone Deacetylase Inhibitors; D003520:Cyclophosphamide; D002066:Busulfan