A 62-year-old man presents with progressive pancytopenia, recurrent sinopulmonary infections, and easy bruising over four months. CBC shows hemoglobin 7.4 g/dL, absolute neutrophil count 550/μL, and platelets 42,000/μL. Peripheral smear reveals pseudo-Pelger-Huet neutrophils, dysplastic red cells, and 2% circulating myeloblasts. Bone marrow biopsy demonstrates hypercellular marrow with trilineage dysplasia, 6% myeloblasts, and micromegakaryocytes with 12% ring sideroblasts. Cytogenetic analysis reveals the karyotype marked **B** in the diagram. Based on this cytogenetic finding and the IPSS-R risk stratification system, what is the most appropriate next step in management for this patient?
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