This non interventional study examines the feasibility of using patient specific therapeutic screening method, ex vivo to enhance current treatment recommendations in a clinically feasible time frame of 30 days.

This study utilizes the Notable Labs personalized testing service using an ex vivo assay, but does not involve actual treatment or treatment determinations. The results of these screenings will be made available to patients and their physicians for their use off study.

The primary objective of the study is:

• To determine the feasibility of selecting patient specific treatment regimens based on ex vivo within 30 days

The exploratory objectives of the study are:

• To identify biomarkers that explain ex vivo drug sensitivity results

Inclusion Criteria:

• Provide informed consent;
• Myelodysplastic syndrome as defined by WHO classification (see Appendix 2), or MDS/MPN with >= 5% blasts in the bone marrow or peripheral blood, including chronic myelomonocytic leukemia (CMML) 1 and 2 by WHO classification
• Relapsed/refractory disease, defined as failed or are ineligible for hypomethylating agent therapy
• Cytogenetics reported

Exclusion Criteria:

• Hypoplastic MDS
• Patients without adequate marrow samples for ex vivo analysis

The study will be conducted at a single site, namely Stanford's MDS Center.