This study tests the combination of **canakinumab** and **darbepoetin alfa** in patients with a blood disorder called **MDS** (Myelodysplastic Syndromes) who haven't responded to previous treatments. MDS is a condition where bone marrow doesn't make enough healthy blood cells. **ESA** (Erythropoietin Stimulating Agents) are medicines that help the body make more red blood cells. The study is open-label, meaning doctors and patients know what treatment is being given. It will be conducted in two phases: first to find a safe dose, and then to see how well it works.

• The study includes several visits, as it is divided into two parts for dose finding and effectiveness.
• Participants need to have a specific type of MDS and should not have certain health conditions like active infections or heart problems.
• Women who can become pregnant must use birth control and pass a pregnancy test before joining.