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However, the best solution would be to gain a general agreement on specific response criteria for patients receiving AML stabilizing therapy. How should quality of life be evaluated in early clinical trials Quality of life is reduced in AML patients particu larly at the time of diagnosis, due to the symptoms and signs of the disease, the information about the diagnosis and prognosis, supplier AP24534 and the initial treatment, but it usually improves and stabilizes, There is no differ ence in QoL in older AML patients receiving intensive or non intensive treatment when comparing the pre treatment basic values, and the values after diagnosis and during treatment, Different instruments and questionnaires are used to quantitatively measure QoL in AML, as well as in other hematologic malignancies, but the European Organization for Research and Treatment of Cancer QLQ C30 questionnaire is one of the most commonly used scientific tools, Evaluation of QoL is often not included in early phase II studies, but is important in larger randomized trials. An alternative for phase II studies is to report parameters, such as time in hospital versus days at home, to describe the situation of the patients, and such factors are most likely important for the patients QoL. Since previous studies have shown that QoL is related to response to therapy, it is likely that treatment induced disease stabilization or even remis sion induction due オーダー AT7519 to low intensity treatment would lead to an improvement in QoL. Review and conclusion Epigenetic strategies in AML are regarded as promising. The detection of reversible epigenetic changes reflected in the chromatin structure has increased our understanding of leukemia development ATP-competitive Akt 阻害剤 and identified new therapeutic targets, In addition to clinical trials with HDAC inhibitors, the number of trials with demethylating agents is also increasing and the combination of these two epigen etic strategies seem to have synergistic effects, HDAC inhibitor monotherapy has limited effects in AML and this treatment should be combined with other antileukemic agents in future clinical studies, Particularly in the treatment of older AML patients, new targeted therapies should be tried and epigenetic strategies then represent well tolerated alternatives. Further increase of response rates can hopefully be made through development of low toxicity combination therapy. Thus, in future, HDAC inhibitors should form part of the AML treatment, at least for older patients or patients unfit for intensive chemotherapy. A future role of VPA in the treatment of myeloproliferative diseases, including AML, is also supported by recent observations suggesting that this agent may be useful in chronic myeloproliferative neoplasms, The available studies of VPA therapy in human AML have demonstrated that HDAC inhibition is a therapeutic strategy that should be investigated further. Future clinical studies should address the question of whether VPA, or any other drugs, should be the preferred HDAC inhibitor and investigate the optimal drug to combine with HDAC inhibition. Randomized clinical trials are also needed to compare HDAC inhibition with alternative therapeutic approaches.