Azacitidine is a nucleoside analog used primarily in the treatment of myelodysplastic syndromes (MDS) and certain types of acute myeloid leukemia (AML). It works by incorporating into DNA and RNA, inhibiting DNA methyltransferase, which leads to hypomethylation of DNA and reactivation of silenced tumor suppressor genes, ultimately suppressing abnormal cell proliferation. Azacitidine was first synthesized in the 1960s and later developed clinically in the 1980s by researchers at Celgene Corporation to provide a novel therapy for MDS, offering an alternative to conventional chemotherapy. Over the decades, it has become a key treatment in hematology-oncology, improving survival and quality of life for patients with hematologic malignancies.