This is an extension study to investigate long term safety and efficacy of SyB C-1101 when orally administered every 3 weeks, twice daily for 14 consecutive days to the patients who have completed 6 cycles in the study 2012002 whose purpose is to investigate tolerability of SyB C-1101 when administered orally in patients with recurrent/relapsed or refractory myelodysplastic syndrome.

Inclusion Criteria:

Patients must satisfy the following conditions listed below.

1. Patients enrolled in the study 2012002 of SyB C-1101 in Patients With Myelodysplastic Syndrome.

2. Patients who were not judged as disease progression* nor progressive disease/relapse** at the end of the cycle 6 in the study 2012002. * hematologic remission according to IWG 2006 criteria ** hematologic improvement according to IWG 2006 criteria

3. Patients who met the continuation criteria*** after Cycle 6 week 3 (Day 22±3) in the study 2012002.

   ***defined in the study 2012002 protocol "4.5 Criteria for Transition to the Next Cycle "

4. Patients who can be expected to survive at least three months or longer.

5. Patients who have score of 0 to 2 in Eastern Cooperative Oncology Group (ECOG) Performance Status (PS).

6. Patients with adequate function in major organs (heart, lungs, liver, kidneys, etc.).

   • Aspartate aminotransferase (AST): no more than 3.0 times the upper boundary of the reference range at each institution
   • Alanine aminotransferase (ALT): no more than 3.0 times the upper boundary of the reference range at each institution
   • Total bilirubin: no more than 1.5 times the upper boundary of the reference range at each institution
   • Serum creatinine: no more than 1.5 times the upper boundary of the reference range at each institution
   • ECG: no abnormal findings requiring treatment
   • Echocardiography: no abnormal findings requiring treatment

7. Patients who personally signed an informed consent document for participation in this study.

Exclusion Criteria:

Patients who satisfy any of the following conditions after Cycle 6 week 3 (Day 22±3) in the study 2012002 will not be enrolled in the study.

1. Patients with anemia caused by factors other than MDS(hemolytic anemia, gastrointestinal hemorrhage, etc.).

2. Patients with obvious infectious diseases (including viral infections).

3. Patients with serious complications (liver failure, renal failure, etc.).

4. Patients with a complication of serious heart disease (myocardial infarction, ischemic heart disease, etc.)

5. Patients with a serious gastrointestinal condition (severe or significant nausea/vomiting, diarrhea, etc.)

6. Patients with serious bleeding tendencies (disseminated intravascular coagulation (DIC), internal hemorrhage, etc.).

7. Ascites or pleural fluid requiring active medical management including paracentesis, or hyponatremia (defined as serum sodium value of < 130 mEq/L).

8. Patients with known allergy to polyethylene glycol or gelatin capsules.

9. Patients with an addiction to a legal or illegal drug, or with alcohol dependency.

10. Patients who are nursing, pregnant or may become pregnant, or lactating mothers.

11. Patients who have not consented to the following contraceptive measures. Patients will avoid sexual intercourse with sexual partners or should use the following contraceptive methods in these time periods: for male patients during the administration period of the trial and for six months after the end of administration; female patients during the administration period of the trial and until a second menstrual period is confirmed after the end of administration (or in the case of female patients with no menstrual period, for two months after the end of administration). 1) Male patients: Patients will always use a condom.

    For effective contraception, it is recommended that the female partner also use the contraceptive methods for female patients. 2) Female patients: Female patients who may become pregnant should use one or more types of the following contraceptive methods. In addition, the male partner will always use a condom.

    • Oral contraceptive (birth control pills)
    • Intrauterine device (IUD)
    • Tubal ligation

12. Other patients judged to be unsuitable by an investigator or sub-investigators.