Decitabine in Treating Patients With Myelofibrosis

Inclusion Criteria:

Patients must have histologically or cytologically confirmed myeloid metaplasia with myelofibrosis (this includes all subtypes - chronic idiopathic myelofibrosis or angiogenic myeloid metaplasia, post thrombocythemic and post polycythemic myelofibrosis); patients must have anemia (hemoglobin < 11 g/dL) or palpable splenomegaly (measured in cm from costal margin - to be eligible); patients with palpable splenomegaly must have spleen size documented ultrasonographically as well; they must also meet standard diagnostic criteria for MMM
Patients with morphologic evidence of advanced phases of the disease including accelerated (10-19% blasts) phase or with evidence of evolution to acute leukemia (>= 20% blasts) are also eligible for this study

The Italian Diagnostic Criteria for MMM

Necessary criteria

Diffuse bone marrow fibrosis
Absence of the Philadelphia chromosome or BCR-ABL rearrangement in peripheral blood cells

Optional criteria

Splenomegaly of any grade
Anisopoikilocytosis with tear drop erythrocytes
Presence of circulating immature myeloid cells
Presence of circulating erythroblasts
Presence of clusters of megakaryoblasts and anomalous megakaryocytes in bone marrow sections
Myeloid metaplasia

Diagnosis of MMM is acceptable if the following combinations are present

The two necessary criteria plus any other two optional criteria when splenomegaly is present OR
The two necessary criteria plus any other four optional criteria when splenomegaly is absent
Patients may have had prior chemotherapy or radiation therapy including splenic irradiation; prior therapy with erythropoietin, granulocyte-colony stimulating factor (GCSF), other growth factors or androgenic steroids is also permitted; there is no limit to the number of prior regimens received; at least 4 weeks must have elapsed since prior chemo or radiation therapy; at least 2 weeks must have elapsed since growth factor (erythropoietin, GCSF, granulocyte-macrophage colony-stimulating factor [GM-CSF]) or other therapy
Eastern Cooperative Oncology Group (ECOG) performance status =< 2 (Karnofsky >= 60%)

Total bilirubin =< 2mg/dL

In patients with associated hemolytic anemia; total bilirubin > 2mg/dL is permissible as long as this is as a result of predominantly unconjugated hyperbilirubinemia; such patients may be enrolled only after discussion with the study chair
Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT])/alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT]) =< 3 x institutional upper limit of normal unless due to disease
Serum creatinine =< 2mg/dL
Patients must not be pregnant or nursing; women of child- bearing potential and men must agree to use an effective contraceptive method; should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately
Ability to understand and the willingness to sign a written informed consent document

Exclusion Criteria:

Prior therapy with decitabine
Patients who have had chemotherapy or radiotherapy within 4 weeks (6 weeks for nitrosoureas or mitomycin C) prior to entering the study or those who have not recovered from adverse events due to agents administered more than 4 weeks earlier
Patients may not be receiving any other investigational agents
Patients with known central nervous system (CNS) disease should be excluded from this clinical trial
History of allergic reactions attributed to compounds of similar chemical or biologic composition to decitabine
Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
Pregnant women are excluded from this study; breastfeeding should be discontinued if the mother is treated with decitabine
Human immunodeficiency virus (HIV)-positive patients receiving combination anti-retroviral therapy are excluded from the study