A 68-year-old woman presents with progressive fatigue and dyspnea on exertion. Laboratory investigations reveal hemoglobin 7.2 g/dL (macrocytic), platelet count 450,000/μL, and neutrophil count 2,800/μL. Bone marrow examination shows erythroid hypoplasia with monolobated megakaryocytes and <5% blasts. Cytogenetic analysis demonstrates the abnormality marked **C** in the diagram. Which of the following is the most appropriate first-line treatment for this patient?
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