After HMA failure, patients with MDS or AML receive traditional AML-like chemotherapies, which include low-dose cytarabine, the combination of cytarabine and daunorubicin, purine nucleoside analogs, or investigational treatment (inhibitors targeting PD-1, CTLA-4, Ras, BCL-2, IDH1 and IDH2 mutations, TLR-2, AXL, TGF-beta, spliceosome, NED88 activating enzyme), some of which also benefit from switching to another nucleoside analog (52–72). The gene discussed is CTLA4; the disease is acute myeloid leukemia.