title: Clinical Results of Hypomethylating Agents in AML Treatment.
abstract: Epigenetic changes play an important role in the development of acute myeloid leukemia (AML). Unlike gene mutations, epigenetic changes are potentially reversible, which makes them attractive for therapeutic intervention. Agents that affect epigenetics are the DNA methyltransferase inhibitors, azacitidine and decitabine. Because of their relatively mild side effects, azacitidine and decitabine are particularly feasible for the treatment of older patients and patients with co-morbidities. Both drugs have remarkable activity against AML blasts with unfavorable cytogenetic characteristics. Recent phase 3 trials have shown the superiority of azacitidine and decitabine compared with conventional care for older AML patients (not eligible for intensive treatment). Results of treatment with modifications of the standard azacitidine (seven days 75 mg/m(2) SC; every four weeks) and decitabine (five days 20 mg/m(2) IV; every four weeks) schedules have been reported. Particularly, the results of the 10-day decitabine schedule are promising, revealing complete remission (CR) rates around 45% (CR + CRi (i.e., CR with incomplete blood count recovery) around 64%) almost comparable with intensive chemotherapy. Application of hypomethylating agents to control AML at the cost of minimal toxicity is a very promising strategy to "bridge" older patients with co-morbidities to the potential curative treatment of allogeneic hematopoietic cell transplantation. In this article, we discuss the role of DNA methyltransferase inhibitors in AML.
authors.affiliation: Department of Hematology, Radboud University Medical Center, PO Box 9191, 6500 HB Nijmegen, The Netherlands. marjan.cruijsen@radboudumc.nl.
authors.forename: Marjan
authors.initials: M
authors.lastname: Cruijsen
authors.affiliation: Department of Medicine, University of Freiburg Medical Center, D-79106, Freiburg, Germany. michael.luebbert@uniklinik-freiburg.de.
authors.forename: Michael
authors.initials: M
authors.lastname: Lübbert
authors.affiliation: Department of Hematology, Haga Hospital, 2545 CH, The Hague, The Netherlands. p.wijermans@hagaziekenhuis.nl.
authors.forename: Pierre
authors.initials: P
authors.lastname: Wijermans
authors.affiliation: Department of Hematology, Radboud University Medical Center, PO Box 9191, 6500 HB Nijmegen, The Netherlands. gerwin.huls@radboudumc.nl.
authors.forename: Gerwin
authors.initials: G
authors.lastname: Huls
keywords: AML; azacitidine; decitabine; elderly; epigenetics; hypomethylating agents