This study looks at how safe the drug SX-682 is for people with Myelodysplastic Syndrome (MDS), a condition where bone marrow doesn’t make enough healthy blood cells. Participants will take SX-682 by mouth twice a day for six cycles, each lasting 28 days. The dose of SX-682 will start at 25 mg and may increase to find the safest dose. If you respond well, treatment may continue. Some patients will also receive another drug, Decitabine.

People with different risks of MDS will be grouped based on their condition and previous treatments. Those who have tried other treatments like Hypomethylating Agents (HMA) or lenalidomide without success are eligible. To join, you must have a specific performance status, lab results, and life expectancy. Women and men must agree to use birth control. You cannot participate if you have used certain medications recently, have serious heart or other health issues, or have had recent surgeries.

• Expect to attend multiple visits over 6 months for the study.
• Participants must not have recent severe illnesses or treatments.
• No concurrent MDS treatments are allowed during this study.