Guadecitabine in Treating Patients With Higher-Risk Myelodysplastic Syndromes

Inclusion Criteria

• •Patients with higher risk MDS (International Prognostic Scoring System \[IPSS\] int-2 or high; or \>= 10% blasts as defined by World Health Organization \[WHO\])
• •* No prior intensive chemotherapy or high-dose cytarabine (\>= 1 g/m\^2)
• •* Prior biologic therapies (=\< 1 cycle of prior decitabine or azacitidine), targeted therapies, or single agent chemotherapy is allowed
• •* Off chemotherapy for 2 weeks prior to entering this study with no toxic effects of that therapy, unless there is evidence of rapidly progressive disease
• •* Hydroxyurea is permitted for control of counts prior to treatment
• •* Hematopoietic growth factors are allowed
• •Eastern Cooperative Oncology Group (ECOG) performance status =\< 2
• •Serum creatinine =\< 1.5 mg/dL
• •Serum bilirubin =\< 1.5 x upper limit of normal (ULN)
• •Aspartate transaminase (AST) or alanine transaminase (ALT) =\< 2.5 x ULN
• •Alkaline phosphatase =\< 2.5 x ULN
• •Provide signed written informed consent
• •Capable of understanding the investigational nature, potential risks and benefits of the study, and able to provide valid informed consent
• •Female patients of childbearing potential must have a negative pregnancy test within 2 weeks prior to entering this study
• •Women who are able to become pregnant and men who can father a child must use birth control while on study and for at least 8 weeks after your last dose of study drug(s); acceptable birth control includes a condom or a diaphragm with spermicidal jelly; and birth control methods that are taken by mouth, injected, or implanted; if you are already using birth control, you must check with the study staff to make sure that it is considered one of the acceptable forms to use in this study