title: The role of hypomethylating agents in myelodysplastic syndrome: changing the management paradigm.
abstract: Modern treatment of myelodysplastic syndromes (MDS) with hypomethylating agents (HMAs) such as azacitidine (Vidaza) and decitabine (Dacogen) has changed the clinical landscape of these disorders. Novel drug combinations of HMAs with histone deacetylase inhibitor therapy may synergistically target different dysregulated molecular mechanisms within MDS clones. This article reviews current trial data concerning the use of the main HMAs in MDS patients where intensive chemotherapy and allogeneic stem cell transplantation is generally not an option. Collated data are presented of the clinical response outcomes, toxicity profiles and prognostic response criteria. Vidaza use in low-risk MDS cases, the selected place of allogeneic stem cell transplantation in older patients with significant comorbidity and the novel drug combination strategies for the future are discussed.
authors.affiliation: Division of Hematology, the Chaim Sheba Medical Center, Tel-Hashomer, Tel Aviv University, Israel.
authors.forename: Drorit G
authors.initials: DG
authors.lastname: Merkel
authors.forename: Arnon
authors.initials: A
authors.lastname: Nagler
mesh_terms: D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D001374:Azacitidine / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D015254:DNA Modification Methylases / Q000037:antagonists & inhibitors / Q000378:metabolism; D000077209:Decitabine; D004359:Drug Therapy, Combination; D056572:Histone Deacetylase Inhibitors / Q000627:therapeutic use; D006801:Humans; D009190:Myelodysplastic Syndromes / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery; D011379:Prognosis; D033581:Stem Cell Transplantation
chemical_list: D000964:Antimetabolites, Antineoplastic; D056572:Histone Deacetylase Inhibitors; D000077209:Decitabine; D015254:DNA Modification Methylases; D001374:Azacitidine