Xpreza Injection contains azacitidine, a hypomethylating agent approved for the treatment of all subtypes of Myelodysplastic Syndromes (MDS). This innovative therapy works by reactivating tumor suppressor genes through DNA demethylation, offering a targeted approach to managing blood cancers. Administered as a subcutaneous injection or intravenous infusion, Xpreza is typically given in 7-day treatment cycles. While not curative, it can significantly improve blood counts, reduce transfusion dependence, and delay progression to acute myeloid leukemia (AML). Patients require regular hematological monitoring throughout treatment to assess response and manage potential side effects.

Uses of Xpreza Injection:

• Treatment of all FAB and WHO classification subtypes of MDS
• Therapy for chronic myelomonocytic leukemia (CMML)
• Management of AML with 20-30% blasts
• Off-label use for certain lymphomas under specialist care

Benefits of Xpreza Injection:

• Only approved hypomethylating agent for all MDS subtypes
• Can reduce transfusion dependency
• Delays progression to AML
• Improves quality of life measures
• Outpatient administration possible

Side Effects of Xpreza Injection:

Very common (>10%):
• Injection site reactions (erythema, pain, swelling)
• Hematologic toxicity (neutropenia, thrombocytopenia)
• Gastrointestinal disturbances (nausea, vomiting, diarrhea)
• Fatigue
• Fever

Serious (1-10%):
• Febrile neutropenia
• Pneumonia
• Renal toxicity
• Hepatic enzyme elevations

How to Use Xpreza Injection?

• Standard regimen: 75mg/m² daily for 7 days every 28 days
• Administration: Subcutaneous (preferred) or intravenous
• Dose adjustment: Based on hematologic response and toxicity
• Monitoring: CBC before each cycle and as clinically indicated
• Duration: Minimum 4-6 cycles to assess response

How Xpreza Injection Works?

Xpreza (azacitidine) is a pyrimidine nucleoside analog that incorporates into DNA and RNA. Its primary antineoplastic activity results from DNA hypomethylation at low doses, reversing epigenetic silencing of tumor suppressor genes. At higher concentrations, it directly inhibits DNA methyltransferases and induces cytotoxicity through incorporation into nucleic acids, preferentially affecting abnormal hematopoietic cells in the bone marrow.

Safety Advice:

• Pregnancy: Category D – Absolute contraindication
• Contraception: Required during and for 6 months post-treatment
• Vaccinations: Avoid live vaccines during treatment
• Renal impairment: Requires dose reduction (CrCl <30mL/min)
• Hepatic impairment: Caution in severe liver dysfunction
• Fertility: May impair fertility – discuss preservation options

What If You Miss a Dose?

Contact your hematologist immediately. Never self-administer missed doses. The treatment team will advise on schedule adjustments based on timing and treatment cycle.

FAQs:

Q1. How is treatment response evaluated?

Response is assessed through serial bone marrow biopsies (after 4-6 cycles) along with hematologic improvement and transfusion independence rates.

Q2. Can Xpreza be given at home?

Subcutaneous administration may be performed at home by trained patients/caregivers, though initial doses should be clinic-administered.

Q3. How long until benefits appear?

Hematologic improvement typically begins by cycle 3-4, with maximal response often requiring 6+ treatment cycles.

Q4. What’s the risk of infection?

Significant – neutropenic precautions are essential. Report any fever >38°C immediately.

Q5. Can I take other medications?

Many drugs interact – especially nephrotoxic agents. Always disclose all medications including OTC products.

Q6. How should injection sites be rotated?

Alternate between arms, thighs, and abdomen with each dose, keeping ≥2 inches from previous sites.

Q7. What blood counts require dose holds?

ANC <500/µL or platelets <25,000/µL typically delay next cycle until recovery.