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Azacitidine represents a DNA methyltransferase inhibitor breakthrough for myelodysplastic syndrome management in elderly patients or those ineligible for intensive chemotherapy. Hematologists employ this demethylating agent to promote differentiation and restore normal hematopoiesis through epigenetic mechanisms. Treatment requires comprehensive baseline bone marrow assessment, cytogenetic analysis, and performance status documentation to guide therapy selection and baseline monitoring. Patients receiving azacitidine must maintain consistent subcutaneous or intravenous injection schedules, regular hematologic monitoring through complete blood counts, and ongoing communication with their hematology team regarding bruising, bleeding tendencies, or infection symptoms.