MDS Unit, Hematology, Department of Experimental and Clinical Medicine, AOU Careggi, University of Florence, Florence, Italy.
Department of Hematology, VU University Medical Center, Amsterdam, the Netherlands.
Crit Rev Oncol Hematol. 2019 Aug;140:1-7. doi: 10.1016/j.critrevonc.2019.05.013. Epub 2019 May 25.
The hypomethylating agents (HMAs), decitabine and azacitidine, are valuable treatment options in acute myeloid leukemia patients who are not eligible for intensive chemotherapy. Both agents are generally well tolerated, and complications most commonly relate to myelosuppression. Antibiotic / antifungal use, regular monitoring, and proactive patient education are important to minimize these events, and reduce the need for dose delay. Responses to HMAs are often not evident for up to 6 cycles, and there is currently no validated clinical marker for predicting response. Hence, treatment should be continued for at least 4-6 cycles to ensure that patients have sufficient opportunity to respond. Delivery of insufficient numbers of cycles is a key reason for HMA failure, and premature discontinuation must be avoided. Genetic factors offer potential for better predicting responders to HMAs in future, but require further study.
低甲基化剂（HMAs），地西他滨和阿扎胞苷，是不适合强化化疗的急性髓系白血病患者的有价值的治疗选择。这两种药物通常耐受性良好，最常见的并发症与骨髓抑制有关。抗生素/抗真菌药物的使用、定期监测和积极的患者教育对于最大限度地减少这些事件并减少剂量延迟非常重要。HMAs 的反应通常在 6 个周期内不明显，目前没有经过验证的临床标志物来预测反应。因此，至少应继续治疗 4-6 个周期，以确保患者有足够的机会做出反应。给予的周期数不足是 HMA 治疗失败的一个关键原因，必须避免过早停药。遗传因素为未来更好地预测 HMAs 的反应者提供了潜力，但需要进一步研究。
