Decitabine is believed to exert its antineoplastic effects after phosphorylation and direct incorporation into DNA and inhibition of DNA methyltransferase, causing hypomethylation of DNA and cellular differentiation or apoptosis.

15 mg/m² administered by continuous IV infusion over 3 hours repeated every 8 hours for 3 days, every six weeks for a minimum of 4 cycles. Treatment may be continued as long as the patient continues to benefit.

Indicated for the treatment of patients with MDS, including previously treated and untreated, de novo and secondary MDS of all French-American-British subtypes (refractory anemia, refractory anemia with ringed sideroblasts, refractory anemia with excess blasts, refractory anemia with excess blasts in transformation, and chronic myelomonocytic leukemia) and intermediate-1, intermediate-2, and high-risk International Prognostic Scoring System groups.

Myelosuppression, including neutropenia, thrombocytopenia, anemia, and febrile neutropenia.

Nausea, vomiting, diarrhea, constipation.

Fever, edema, hyperglycemia, hypomagnesemia, hypokalemia, arthralgias, back pain, cough, headache, insomnia, rash, petechiae, and pallor.

Patients may be premedicated with standard anti-emetic therapy.

Bone marrow suppression is the most frequent cause of dose reduction, delay, and discontinuation. Refer to prescribing information.

If not used within 15 minutes of reconstitution, the solution must be prepared using cold (2°-8°C) infusion fluids and stored at 2°-8°C (36°-46°F) for up to a maximum of seven hours until administration.