TET2 Mutations in Myelodysplastic Syndromes and Acute Myeloid Leukemia With Azacitidine + Ascorbic Acid

Inclusion Criteria:

Patients must have a confirmed heterozygous TET2 mutations identified by next generation targeted deep sequencing.
Patients must have MDS, or MDS/MPN overlap defined by 2016 World Health Organization (WHO) criteria. Both newly diagnosed or previously treated MDS or MDS/MPN patients are eligible as long as the patient has never received prior treatment with azacitidine or decitabine.
Patients with Leukemic/blast phase transformation MPN.

Patient with AML according to 2016 WHO criteria.

Newly diagnosed patients who are ineligible or declined to receive intensive chemotherapy after discussion of risks and benefits of that approach or patients with primary refractory/relapsed AML.
Patients with active central nervous system (CNS) leukemia eligible at the discretion of treating physician.

Relapse/Refractory is defined as at least 1 course of treatment for AML excluding any patients treated with azacitidine or decitabine.

Patients should be off any prior treatment or line of therapy for 2 weeks prior to start study with the exception of hydrea (Hydroxyurea).
Prior therapy with hydroxyurea, biological or targeted therapy (e.g. flt3 inhibitors, other kinase inhibitors) or hematopoietic growth factors is allowed.
Eastern Cooperative Oncology Group (ECOG) performance status ≤ 3.
Patients must have normal organ and marrow function as defined at the discretion of the treating physician and PI.
Women of childbearing potential must have a negative serum or urine pregnancy test within 10-14 days prior to enrollment.
Patients must have the ability to understand and the willingness to sign a written informed consent document.
Patient must be willing to comply with all aspects of the protocol including completing the drug diary.
Patient must discontinue any and all use of multivitamin and/or vitamin c medication 24 hours before first dose of Ascorbic Acid.

Exclusion Criteria:

Any prior treatment with azacitidine or decitabine.
Patients diagnosed with acute promyelocytic leukemia (APL), AML-M3.
Patients receiving other active treatment for their myeloid malignancy including investigational agents with the exception of hydrea for white blood cell control.
Nursing or pregnant women.
History of allergic reactions to either azacitidine or ascorbic acid.
Patients with uncontrolled intercurrent illness including, but not limited to ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements.
Patients with higher risk of bleeding (deemed by the treating physician) or on anticoagulation.
Patients who are unwilling or unable to comply with all study requirements.