Birinapant With 5-azacitidine in MDS Subjects Who Are Naïve, Have Relapsed or Are Refractory to 5-azacitidine Therapy

Inclusion Criteria: * Men or women more than 18 years of age. * Patients with high-risk Myelodysplastic Syndrome * Performance status of greater or equal to 2 by the Eastern Cooperative Oncology Group (ECOG) scale. * Subjects with high-risk MDS who are naïve to 5-Azacitidine or have previously received 5-AZA or decitabine as first-line cytotoxic therapy. Subjects with prior 5-Azacitidine therapy were evaluated to be either refractory or relapsed as determined by the Investigator, according to IWG response criteria.Subjects with relapsed or refractory disease may have only received prior 5-Azacitidine or decitabine. * Hydroxyurea for patients with rapidly proliferative disease can be used up to 24 hours prior to therapy but not concomitantly with 5-Azacitidine. * Adequate liver, pancreatic and renal function. * Women of childbearing potential must have a negative serum pregnancy test at screening within 48 hours prior to the first dose * Women of childbearing potential must agree to use 2 methods of adequate contraception Exclusion Criteria: * Subjects with life-threatening toxicity or non tolerability to prior 5-Azacitidine therapy. * Subjects with hypoplastic Myelodysplastic syndrome. * Subjects with \>30% bone marrow blast cells. * Subjects with malignant hepatic tumors or secondary malignancy within 2 years * Known diagnosis of human immunodeficiency virus or chronic active Hepatitis B or C. * Uncontrolled hypertension * Impaired cardiac function, uncontrolled cardiac arrhythmias despite medications, * QT interval corrected for heart rate (QTcB) more than 480 msec * Lack of recovery of prior adverse events to Grade ≤1 severity (National Cancer Institute Common Terminology Criteria for Adverse Events version 4) (except alopecia) due to therapy administered prior to the initiation of study drug dosing. * Nursing or pregnant women. * Known allergy to any of the formulation components of birinapant. * Known or suspected hypersensitivity to 5-Azacitidine or mannitol. * Any concurrent disease and/or medical condition that, in the opinion of the Investigator, would prevent the subject's participation. * History of Bell's Palsy.