This is an expanded access program in which the drug being tested is called pevonedistat, which is used in combination with azcitidine. This study will provide expanded access of pevonedistat (in combination with azacitidine) for the first-line treatment to participants with HR-MDS and option of real world data (RWD) collection for the benefit of future participants.~All participants will receive azacitidine via intravenous or subcutaneous route in combination with pevonedistat intravenous infusion.~This multi-center trial will be conducted in the United States. Participant will continue treatment until benefit is no longer derived from the treatment (that is, until disease progression, or treatment is no longer tolerable), the benefit-risk no longer favors the individual, an appropriate alternative therapy becomes available, the participant chooses to discontinue the treatment, or pevonedistat becomes commercially available.
Participants in the expanded access program are adults with higher-risk myelodysplastic syndromes who have no other treatment options available.~The main aim of this program is to allow participants to have access to pevonedistat before FDA approval.~This program will take place in the United States.