 Low dose decitabine has demonstrated depletion of DNMT1 in normal hematopoietic stem cells HSC without cytotoxicity and subcutaneous SC instead of intravenous IV administration may avoid high peak levels that can cause apoptosis. Furthermore, the low toxicity associated with low dose decitabine would allow for more frequent 1 to 3 times weekly administration of the drug which would catch more cells in S-phase via greater exposure time. Based on these findings, a starting dose of decitabine 5 mgm2 SC twice weekly should be well tolerated and effective in patients with MF and MPNMDS syndromes when combined with pacritinib 400 mg daily. 