How it is administered

Decitabine is administered as an intravenous (IV) infusion. It is supplied as a sterile, white to off-white lyophilized powder in single-dose vials, which must be reconstituted and further diluted before use.

There are two main dosing regimens for decitabine in adults with myelodysplastic syndromes (MDS):

• Three Day Regimen: 15 mg/m² by continuous IV infusion over 3 hours, every 8 hours for 3 days. This cycle is repeated every 6 weeks.
• Five Day Regimen: 20 mg/m² by continuous IV infusion over 1 hour, daily for 5 days. This cycle is repeated every 4 weeks.

The treatment is given in cycles, and the number of cycles may vary depending on your response and tolerance to the medication. Your healthcare team will monitor your blood counts and adjust the dose or schedule as needed.

How it works

Decitabine is a type of medicine called a nucleoside metabolic inhibitor. It works by affecting the DNA in abnormal blood cells. After entering the cell, decitabine is incorporated into the DNA and blocks an enzyme called DNA methyltransferase. This leads to hypomethylation of DNA, which can restore the normal function of genes that control how cells grow and develop.

In patients with myelodysplastic syndromes (MDS), the bone marrow produces abnormal blood cells. By reducing DNA methylation, decitabine can help these abnormal cells mature and die, or return to a more normal state. This process can improve blood counts and reduce the need for blood transfusions. Decitabine is most effective in rapidly dividing cells, such as those found in MDS and other blood cancers. Non-dividing cells are less affected by the medication.

Who Should take it

Decitabine is approved for the treatment of adult patients with myelodysplastic syndromes (MDS). This includes patients who have been previously treated or untreated, with de novo (newly diagnosed) or secondary MDS, and covers all French-American-British (FAB) subtypes:

• Refractory anemia
• Refractory anemia with ringed sideroblasts
• Refractory anemia with excess blasts
• Refractory anemia with excess blasts in transformation
• Chronic myelomonocytic leukemia (CMML)

It is indicated for patients in intermediate-1, intermediate-2, and high-risk groups according to the International Prognostic Scoring System (IPSS). Your doctor will determine if decitabine is suitable for you based on your specific diagnosis, risk category, and overall health.

Who should not take it

There are no absolute contraindications listed for decitabine, but certain patients should use caution or avoid this medication:

• Pregnant women: Decitabine can cause harm to an unborn baby. Women who are pregnant or may become pregnant should not take decitabine. Effective contraception is recommended during treatment and for 6 months after the last dose for females, and for 3 months for males with female partners.
• Breastfeeding women: Women should not breastfeed during treatment and for at least 2 weeks after the last dose.
• Patients with severe infections or uncontrolled medical conditions: Treatment may need to be delayed until these conditions are managed.
• Patients with severe kidney or liver impairment: The safety of decitabine in these populations is not well studied, so your doctor will weigh the risks and benefits before starting treatment.

Always discuss your full medical history with your healthcare provider before starting decitabine.

Commonly used with

Decitabine is often used alone for the treatment of MDS, but supportive care is commonly provided alongside treatment. This may include:

• Blood transfusions (red blood cells or platelets)
• Growth factors (such as G-CSF for low white blood cells)
• Antibiotics or antifungals to prevent or treat infections

Your doctor may also use other supportive medications to manage side effects, such as antiemetics for nausea.

Commonly tested with

In clinical studies, decitabine has been compared with supportive care alone (such as transfusions and antibiotics) in patients with MDS. It has also been studied in combination with other supportive treatments, but not typically with other chemotherapy drugs for MDS.

Your doctor may order regular blood tests to monitor your response to decitabine and to check for side effects. Bone marrow tests may also be performed to assess how well the treatment is working.