A Case Report on Hypomethylating Agent-Induced Cardiomyopathy

Hypomethylating agents, 5-azacytidine and 5-aza-2'-deoxycytidine (decitabine) , which have an effect by inhibiting DNA methyltransferase have been approved in Myelodysplastic syndrome (MDS). The most common side effects of hypomethylating agents are cytopenias, nausea, pain, and local reactions in injection zones. The toxicity associated with other organ functions is very rare. Our paper reported a case which a decrease was observed in left ventricular ejection fraction (EF) due to Decitabine treatment because of no response to Azacitidine as the fourth case in the literature.

Three cases with cardiac toxicity and function loss have been reported in the literature. our case did not undergo ECHO check before starting Decitabine treatment after Azacitidine, it cannot be clearly understood whether cardiac toxicity occurred with 10 cycles of Azacitidine or 1 cycle of Decitabine treatment. Randomized controlled trials with large patient series are needed to clarify the etiology and pathophysiology of this side effect.