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The histone deacetylase (HDAC) inhibitor valproic acid as monotherapy or in combination with all‐trans retinoic acid in patients with acute myeloid leukemia
Author(s) -
Kuendgen Andrea,
Schmid Mathias,
Schlenk Richard,
Knipp Sabine,
Hildebrandt Barbara,
Steidl Christian,
Germing Ulrich,
Haas Rainer,
Dohner Hartmut,
Gattermann Norbert
Publication year - 2005
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.21552
Subject(s) - medicine , valproic acid , myeloid leukemia , oncology , retinoic acid , myelodysplastic syndromes , tretinoin , histone deacetylase inhibitor , myeloid , histone deacetylase , cytarabine , pharmacology , chemotherapy , epilepsy , bone marrow , histone , biology , biochemistry , psychiatry , gene
BACKGROUND Valproic acid (VPA) inhibits histone deacetylase activity and, synergizing with all‐trans retinoic acid (ATRA), achieves differentiation induction of myeloid blast cells in vitro. METHODS We used VPA in 58 patients with acute myeloid leukemia (AML) who were too old and/or medically unfit to receive intensive chemotherapy (32 AML secondary to myelodysplastic syndrome [MDS], 22 de novo AML, 4 AML secondary to myeloproliferative syndrome). VPA serum concentrations were 50–100 μg/mL. Thirty‐one patients received VPA monotherapy. ATRA was added later in 13 patients who did not respond or who relapsed. Another 27 patients received VPA plus ATRA from the start. Median treatment duration was 93 days for VPA and 88 days for ATRA. RESULTS The response rate was only 5% according to International Working Group (IWG) criteria for AML but was 16% when IWG response criteria for MDS were used, which capture hematologic improvement and stabilization of the disease. These endpoints, which are not necessarily correlated with diminishing blast counts, are relevant for the patients' quality of life. Among 23 patients with a peripheral blast count > 5%, 6 (26%) showed a diminishing blast count, and 5 of these had a complete peripheral blast clearance. CONCLUSIONS Future trials should combine VPA with chemotherapy or demethylating agents. Cancer 2006. © 2005 American Cancer Society.