Inclusion Criteria:

          -  Signed informed consent must be obtained prior to participation in the study

          -  Age ≥ 18 years at the date of signing the informed consent form

          -  Morphologically confirmed diagnosis of myelodysplastic syndrome (MDS) based on WHO
             2016 classification (Arber et al 2016) by local investigator assessment with one of
             the following Prognostic Risk Categories, based on the revised International
             Prognostic Scoring System (IPSS-R):

               -  Very high (> 6 points)

               -  High (> 4.5 - ≤ 6 points)

               -  Intermediate (> 3 - ≤ 4.5 points) Or Morphologically confirmed diagnosis of
                  Chronic Myelomonocytic Leukemia -2 based on WHO 2016 classification (Arber et al
                  2016, including persistent monocytosis) by local investigator assessment with WBC
                  < 13 x 109/L at time of initial diagnosis

          -  Indication for azacitidine treatment according to the investigator, based on local
             standard medical practice and institutional guidelines for treatment decisions

          -  Not eligible at time of screening for intensive chemotherapy according to the
             investigator, based on local standard medical practice and institutional guidelines
             for treatment decisions, including assessment of individual clinical factors such as
             age, comorbidities and performance status

          -  Not eligible at time of screening for hematopoietic stem cell transplantation (HSCT)
             according to the investigator, based on local standard medical practice and
             institutional guidelines for treatment decisions, including assessment of individual
             clinical factors such as age, comorbidities, performance status, and donor
             availability

          -  Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1 or 2

        Exclusion Criteria:

          -  Prior exposure to TIM-3 directed therapy at any time. Prior therapy with immune
             checkpoint inhibitors (e.g, anti-CTLA4, anti-PD-1, anti-PD-L1, or anti-PD-L2), cancer
             vaccines is allowed except if the drug was administered within 4 months prior to
             randomization

          -  Previous first-line treatment for intermediate, high, very high risk myelodysplastic
             syndromes (based on IPSS-R) or CMML with any antineoplastic agents including for
             example chemotherapy, lenalidomide and hypomethylating agents (HMAs) such as
             decitibine and azacitidine. However, previous treatment with hydroxyurea or
             leukopheresis to reduce WBC count is allowed prior to randomization.

          -  Investigational treatment received within 4 weeks or 5 half-lives of this
             investigational treatment, whatever is longer, prior to randomization. In case of a
             checkpoint inhibitor: a minimal interval of 4 months prior to randomization is
             necessary to allow randomization.

          -  Subjects with Myelodysplastic syndrome (MDS) based on 2016 WHO classification (Arber
             et al 2016) with revised International Prognostic Scoring System (IPSS-R) ≤ 3

          -  Diagnosis of acute myeloid leukemia (AML) including acute promyelocytic leukemia and
             extra-medullary acute myeloid leukemia, primary or secondary myelofibrosis based on
             WHO 2016 classification (Arber et al 2016)

          -  Diagnosis of therapy related myeloid neoplasms based on WHO 2016 classification (Arber
             et al 2016)

          -  History of organ or allogeneic hematopoietic stem cell transplant

        Other protocol-defined Inclusion/Exclusion Criteria may apply.