Clinical results with the DNA hypomethylating agent 5-aza-2'-deoxycytidine (decitabine) in patients with myelodysplastic syndromes: an update.
Patients with myelodysplastic syndromes (MDS), especially those with high-risk disease, other comorbidities, or of advanced age, still have a limited prognosis. In addition to cytotoxic chemotherapies, hypomethylating agents such as decitabine (5-aza-2'-deoxycytidine) and azacitidine (5-azacytidine), have been approved during the past decade and represent a very important option for the treatment of MDS today. Due to their lower toxicity compared to conventional chemotherapy, hypomethylating agents are often a safe and feasible alternative also for frail patients. Decitabine has been shown to be active in numerous studies including International Prognostic Scoring System (IPSS) intermediate-1 to high risk patients, in secondary acute myeloid leukemia (AML) arising from MDS, and in MDS with poor-risk cytogenetics. Furthermore, decitabine has been studied in the allograft setting and in combination treatment regimens, and may play a role in epigenetic "priming" before conventional chemotherapy. This review summarizes the results of clinical trials and experiences with decitabine not only in first-line and single-agent treatment regimens but also as second-line treatment after prior treatment failure, in the context of the allograft setting and as part of combination treatment regimens.
Department of Hematology/Oncology, University of Freiburg Medical Center, Freiburg, Germany.
Tina E
TE
Joeckel
Michael
M
Lübbert
D000964:Antimetabolites, Antineoplastic / Q000494:pharmacology / Q000627:therapeutic use*; D001374:Azacitidine / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D017321:Clinical Trials, Phase I as Topic; D017322:Clinical Trials, Phase II as Topic; D019175:DNA Methylation / Q000187:drug effects*; D000077209:Decitabine; D006801:Humans; D009190:Myelodysplastic Syndromes / Q000188:drug therapy* / Q000235:genetics*; D011379:Prognosis; D016896:Treatment Outcome
D000964:Antimetabolites, Antineoplastic; D000077209:Decitabine; D001374:Azacitidine