4.A 78-year-old woman with excellent performance status and history of low-risk myelodysplastic syndrome presented with worsening shortness of breath, petechiae, and fatigue. Blood count showed anemia, thrombocytopenia, and peripheral blasts. The patient refused a bone marrow biopsy citing pain and fear of needles. A peripheral blood mutational analysis showed an IDH2 mutation and a normal karyotype. The patient received six cycles of decitabine without improvement in blood counts and with persistence of peripheral blasts. What is the best next step?

A. 7 + 3 induction chemotherapy

B. Hospice referral

C. Enasidenib

D. Supportive care