Azacitidine tablets are a demethylated anti-tumor drug mainly used for the treatment of specific hematological malignancies. Its use must strictly follow the indications and pay attention to key risk factors such as bone marrow suppression. The following provides a detailed explanation of the classification of indications and medication precautions.

1. Indications

(1) Myelodysplastic Syndrome (MDS): Suitable for primary or secondary MDS patients in the International Prognostic Scoring System (IPSS) intermediate risk -2 and high-risk groups.

(2) Acute myeloid leukemia (AML): Used to treat elderly AML patients (usually ≥ 65 years old) who are not suitable for intensified chemotherapy.

(3) Chronic myelomonocytic leukemia (CMML): suitable for CMML-2 patients classified by WHO.

2. Medication precautions

(1) Bone marrow suppression monitoring: Blood routine should be completed before treatment, and whole blood cell count should be monitored weekly during treatment. If there is a grade 3-4 decrease in blood cells, medication should be suspended.

(2) Renal function adjustment: If the creatinine clearance rate is less than 30ml/min, a 50% reduction is required, and it is contraindicated for patients with end-stage renal disease.

(3) Abnormal liver function: When the transaminase level exceeds 5 times the ULN, the medication should be stopped, and when the bilirubin level exceeds 3 times the ULN, it should be prohibited.

(4) Infection prevention: Antibiotics should be used preventively when the neutrophil count is less than 0.5 × 10 ⁹/L, and live vaccines should be avoided.

(5) Drug interactions: Avoid co administration with nephrotoxic drugs, as co administration with CYP450 inducers may reduce efficacy.

3. Medication for special populations

(1) Pregnancy period: It belongs to Class D pregnancy medication, and effective contraception is required during the medication period and 6 months after discontinuation.

(2) Breastfeeding period: Medications can be secreted into breast milk, and breastfeeding should be stopped during the treatment period.

(3) Children: Safety and efficacy have not been established yet, and it is not recommended to use it.

(4) Elderly: No need to adjust dosage, but need to strengthen adverse reaction monitoring.

4. Medication regimen

(1) Standard dose: 75mg/m ² subcutaneous injection or intravenous infusion, once daily for 7 consecutive days, with 28 days as one cycle.

(2) Dose adjustment: Delay administration or reduce dosage to 50mg/m ² based on the recovery of blood count.

(3) Course of treatment: Evaluate efficacy for at least 4-6 cycles, and effective patients can continue treatment until disease progression.