Acute myeloid leukemia (AML) is the most common acute leukemia in adults. Chemotherapy with cytotoxic agents is the standard of care, but is associated with a high rate of adverse events. Elderly patients are frequently intolerant to such treatment, presenting a very poor prognosis. The hypomethylating agents (HMA) azacitidine or decitabine represent one of the main therapeutic alternatives for these patients. Isocitrate dehydrogenase inhibitors (IDH) constitute another therapeutic class with DNA methylation effects in AML. In this article, we review the use of first- and second-generation HMA and IDH inhibitors in AML. The data collected demonstrated that HMA are generally considered effective and safe for AML patients who are not eligible for standard chemotherapy. The combination of azacitidine or decitabine with venetoclax was recently approved by the US Food and Drug Administration (FDA) for older AML patients and those unfit for intense chemotherapy. IDH inhibitors also showed encouraging results for relapsed/refractory AML patients harboring an IDH mutation and received FDA approval. Therefore, recent studies have led to the emergence of new therapeutic options using HMA and IDH inhibitors for specific groups of AML patients, representing an important step in the treatment of this aggressive malignancy. New options should emerge from the ongoing studies in the coming years.

中文翻译：

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急性髓性白血病中DNA甲基化修饰剂的更新。

急性髓细胞性白血病（AML）是成人中最常见的急性白血病。用细胞毒性剂进行化学疗法是标准的治疗方法，但是与不良事件的发生率高有关。老年患者通常不能接受这种治疗，预后很差。次甲基化剂（HMA）阿扎胞苷或地西他滨是这些患者的主要治疗选择之一。异柠檬酸脱氢酶抑制剂（IDH）构成另一类具有AML中DNA甲基化作用的治疗药物。在本文中，我们回顾了第一代和第二代HMA和IDH抑制剂在AML中的使用。收集的数据表明，对于不适合标准化疗的AML患者，HMA通常被认为是有效和安全的。美国食品和药物管理局（FDA）最近批准了将阿扎胞苷或地西他滨与venetoclax的组合用于老年AML患者和不适合进行强化学疗法的患者。对于具有IDH突变并获得FDA批准的复发/难治性AML患者，IDH抑制剂也显示出令人鼓舞的结果。因此，最近的研究导致出现了针对特定组的AML患者使用HMA和IDH抑制剂的新治疗选择的出现，这代表了治疗这种侵袭性恶性肿瘤的重要一步。未来几年，正在进行的研究应会出现新的选择。对于具有IDH突变并获得FDA批准的复发/难治性AML患者，IDH抑制剂也显示出令人鼓舞的结果。因此，最近的研究导致出现了针对特定组的AML患者使用HMA和IDH抑制剂的新治疗选择的出现，这代表了治疗这种侵袭性恶性肿瘤的重要一步。未来几年，正在进行的研究应会出现新的选择。对于具有IDH突变并获得FDA批准的复发/难治性AML患者，IDH抑制剂也显示出令人鼓舞的结果。因此，最近的研究导致出现了针对特定组的AML患者使用HMA和IDH抑制剂的新治疗选择的出现，这代表了治疗这种侵袭性恶性肿瘤的重要一步。未来几年，正在进行的研究应会出现新的选择。