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Abstract
Background: Although originally developed as a cytarabine analog more than 40 years ago, azacitidine has been the subject of renewed interest in the era of cancer epigenetics. Objective: What is the history of the clinical development of azacitidine and how has it been applied successfully to the treatment of myelodysplastic syndromes (MDS)? Methods: We review the evolution of the use of azacitidine for the therapy of human disease and review the major studies that have laid the groundwork for its current clinical indication. Conclusion: The use of azacitidine has changed the approach to the treatment of MDS and has resulted in improved outcomes for patients.