A Phase 1b/2 Study of Ropeginterferon Alfa-2b Added to Azacitidine in MDS/AML With TP53 Mutations

To find the recommended dose of ropeginterferon alfa-2b in combination with azacitidine in patients with newly diagnosed MDS/AML with TP53 mutations. To learn if the recommended dose of ropeinterferon alfa-2b found in Dose Escalation in combination with azacitidine can help to control the disease.

Eligibility Criteria Participants with following: I) Adult participants with MDS/AML with TP53 aberration * TP53 aberration defined by: * Single TP53 mutation\> 10% VAF * \>1 mutation of any VAF, irrespective of cytogenetics or TP53 allele loss * Single TP53 mutation 5-10% with complex karyotype and/or TP53 allele loss * (TP53 mutation will include any known or possible pathogenic missense, truncating or splicing mutations in the UT MD Anderson CLIA lab myeloid NGS panel and validated by molecular pathologist; TP53 allele loss on FISH should be at least \> 5%) a. Cohort1A: R/R MDS/AML ≥ 18years of age, irrespective of eligibility of intensive therapy i) ≥5% blasts in the bone marrow and/or peripheral blood. b.Cohort1B: Newly diagnosed MDS/AML and Ineligible for intensive chemotherapy defined by: i) ≥ 10% blasts ii) Ineligible for intensive chemotherapy * Adult patients ≥ 60 years of age, OR * Adult patients 18 to 60 years of age with at least one of the following relevant clinical situations/status: * Eastern cooperative oncology group (ECOG) performance status ≥2 * Clinically significant organ comorbidities, as reflected by at least 1 of: * Left ventricular ejection fraction (LVEF) \