Azacitidine and Chimerism in MDS or AML Patients After Allogeneic Stem Cell Transplant

Inclusion criteria

• Patients with AML/MDS/MPN, CMML post Allogeneic SCT who experience any drop in total or myeloid chimerism any time after day 30, or their day 30 or day100 myeloid donor chimerism is below 98% without concurrent hematologic relapse (that is, patients with <5% bone marrow blasts as obtained at that time point) will be offered treatment with azacitidine
• >=30 -180 days post SCT and patients must have ANC> 1000, PLT > 50,000
• Age 18-75 years old
• Performance score of at least 70% by Karnofsky
• Adequate kidney and liver function as demonstrated by:

• Creatinine clearance should be >60 ml/min
• Total Bilirubin <1.5, ALT/AST/Alk Phos < 2.5 x normal. No evidence of chronic active hepatitis or cirrhosis.
• Negative Beta HCG test in a woman with child bearing potential, defined as not post-menopausal for 12 months or no previous surgical sterilization. Women of child bearing potential must be willing to use an effective contraceptive measure while on study.
• Patient or patient's legal representative, parent(s) or guardian able to sign informed consent.
• Patients must be off any prior chemotherapy, radiotherapy, or other investigational therapy within 2 weeks prior to start treatment

Exclusion criteria

• Positive for HIV, HBsAg, HCV or other viral hepatitis or cirrhosis from any cause
• Active or prior CNS leukemia, unless in complete remission for at least 2 months.
• History of serious chronic mental disorder or drug-abuse accompanied by documented problems of compliance with therapeutic programs.
• Uncontrolled infection
• Grade III, IV graft versus host disease (GVHD