Tratamiento hipometilante de los síndromes mielodisplásicos. Pasado, presente y futuro… (Partes 1 y 2)

  • Marcelo Iastrebner Servicio de Hematología del Sanatorio Sagrado Corazón
Palabras clave: Síndromes mielodisplásicos, tratamiento hipometilante, experiencia latinoamericana y ensayos clínicos

Resumen

En un artículo(1) sobre terapia epigenética publicado hace poco más de 10 años, decíamos: “... el desarrollo de nuevos tratamientos altamente eficaces que presentan menores efectos secundarios para el paciente plantea un quiebre respecto a la terapéutica oncológica tradicional. Por un lado, ofrecen una expectativa mayor de supervivencia y una mejor calidad de vida, y por el otro, alcanzan a un número extenso de enfermos...”. Después de tanto tiempo transcurrido, cabe preguntarse si dichas expectativas se han hecho realidad. Los agentes hipometilantes (HMAs) han significado sin duda un avance terapéutico en la práctica diaria, pero su efectividad real no ha sido tan contundente como la esperada. Por lo tanto, esta terapéutica ha dejado abierta una amplia brecha entre las necesidades de muchos pacientes y los alcances reales de la misma. En este escenario de controversias se han desarrollado una serie de investigaciones prometedoras que podrían modificar el panorama a corto o mediano plazo. En el presente trabajo se analizarán los logros y las limitaciones del tratamiento hipometilante, procurando delinear futuras posibilidades terapéuticas. Este artículo constará de cuatro partes que tendrán como objetivo responder: ¿qué hemos aprendido en estos últimos 10 años de la experiencia internacional? (parte 1), ¿cómo fue la experiencia local en La-tinoamérica? (parte 2), ¿cuáles son los sistemas de estratificación recientemente validados que predicen resultados en el período post-falla al hipometilante? (parte 3) y ¿qué tratamiento debería utilizarse luego del fracaso al hipometilante? (parte 4).

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Publicado
2019-05-07
Sección
Artículo de revisión