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