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Azacitidine + vorinostat is a combination of two small molecule drugs used primarily in the treatment of hematologic malignancies, especially myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML). Azacitidine is a pyrimidine nucleoside analogue that acts as a DNA methyltransferase inhibitor, leading to hypomethylation of DNA and reactivation of silenced genes involved in cell differentiation and apoptosis[1][3][5]. Vorinostat is a histone deacetylase (HDAC) inhibitor that blocks the activity of HDAC enzymes, resulting in increased acetylation of histones, relaxation of chromatin structure, and reactivation of tumor suppressor genes[2][8]. The combination aims to synergistically reactivate epigenetically silenced genes through dual inhibition—DNA hypomethylation by azacitidine and increased histone acetylation by vorinostat—thereby promoting cell cycle arrest or apoptosis in malignant cells. This regimen has been investigated mainly for relapsed or refractory AML/MDS patients[4][5].
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