Epigenetic therapy in myelodysplastic syndromes.
The wide spectrum of clonal hematopoietic disorders that fall under the broad diagnostic category of myelodysplastic syndromes (MDS) consist of a family of bone marrow malignancies - with ineffective, inadequate, and dysplastic hematopoiesis, and with an increased risk of life-threatening infections, bleeding, and progression to acute myeloid leukemia (AML) - that are characterized by a deep heterogeneity on the clinical, biologic and prognostic level. The intrinsic complexity of this group of disorders and the frequent association with one or more comorbidities have limited for many years the number of effective treatment options available: most patients are, indeed, still managed by supportive care measures, with just a minority of them being eligible for allogeneic stem cell transplantation, which is still the only potentially curative modality. In the last two decades, the progressively better understanding of MDS biology has shown how an abnormal epigenetic modulation might play a crucial part in the pathogenesis and in the process of biologic evolution of these disorders. Moreover, pharmacological agents that target the so-called epigenome have shown a significant clinical activity for diverse hematologic malignancies, including MDS. The aim of this review is to highlight recent developments within the context of current knowledge of MDS and its altered epigenetic regulation and to recall the experimental steps that have brought to the clinical development and application of epigenetic modifiers, such as azacytidine and decitabine, trying to explain the biologic rationale for their use in this setting.
Musolino
Caterina
C
Division of Hematology, University of Messina, Messina, Italy. cmusolino@unime.it
Sant'antonio
Emanuela
E
Penna
Giuseppa
G
Alonci
Andrea
A
Russo
Sabina
S
Granata
Angela
A
Allegra
Alessandro
A
D017766:Acid Anhydride Hydrolases / Q000235:genetics / Q000378:metabolism; D051017:Apoptosis Regulatory Proteins / Q000235:genetics / Q000378:metabolism; D001374:Azacitidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D017871:Calcium-Calmodulin-Dependent Protein Kinases / Q000235:genetics / Q000378:metabolism; D002986:Clinical Trials as Topic; D050762:Cyclin-Dependent Kinase Inhibitor p15 / Q000235:genetics / Q000378:metabolism; D019175:DNA Methylation / Q000187:drug effects; D064550:Death-Associated Protein Kinases; D000077209:Decitabine; D044127:Epigenesis, Genetic / Q000187:drug effects*; D006801:Humans; D015201:Meta-Analysis as Topic; D009190:Myelodysplastic Syndromes / Q000188:drug therapy* / Q000235:genetics* / Q000378:metabolism; D009363:Neoplasm Proteins / Q000235:genetics / Q000378:metabolism; D000099170:Bis(5'-adenosyl)triphosphatase
D017766:Acid Anhydride Hydrolases; D051017:Apoptosis Regulatory Proteins; D001374:Azacitidine; D017871:Calcium-Calmodulin-Dependent Protein Kinases; D050762:Cyclin-Dependent Kinase Inhibitor p15; D064550:Death-Associated Protein Kinases; D000077209:Decitabine; D009363:Neoplasm Proteins; D000099170:Bis(5'-adenosyl)triphosphatase