Clinical Trial to Assess the Efficacy and Toxicity of Induction and Consolidation With CPX-351 for Patients Aged 60 to 75 Years With Secondary or High-risk Acute Myeloid Leukemia

Inclusion Criteria:

1. Written informed consent in accordance with national, local, and institutional guidelines. The patient must provide informed consent prior to the first screening procedure. Informed consent form must be signed by the patient and the investigator.
2. Age 60 to 75 years at the time of diagnosis of AML.
3. Newly confirmed diagnosed of AML according to WHO 2008 criteria.
4. Secondary or high risk AML, defined as one of the following:

   * t-AML: documentation of prior cytotoxic therapy or radiation therapy for an unrelated disease in a discharge summary or pharmacy records or radiation therapy records
   * MDSAML: bone marrow documentation of MDS prior to diagnosis of AML (could have been treated previously with hypomethylating or standard chemotherapy)
   * CMMoLAML: bone marrow documentation of CMMoL prior to diagnosis of AML (could have been treated previously with hypomethylating or standard chemotherapy)
   * de novoAML with FISH or cytogenetic changes linked to MDS per WHO 2016 criteria.
5. Eastern Cooperative Oncology Group (ECOG) performance status of 0-2.
6. Ability to adhere to the study visit schedule and other protocol requirements.
7. Laboratory values fulfilling the following:

   * Serum creatinine \< 2.0 mg/mL
   * Serum alanine aminotransferase (ALT) or aspartate aminotransferase (AST) or total bilirubin \< 3 times the upper limit of normal (ULN, subjects with elevated liver enzymes related to disease were instructed to contact the Sponsor) (subjects with Gilbert's Syndrome were instructed to contact the sponsor).
8. Subjects with second malignancies in remission may have been eligible if there was clinical evidence of disease stability for a period ≥ 6 months off cytotoxic chemotherapy, documented by imaging, tumor marker studies at screening. Subjects maintained on long-term nonchemotherapy treatment such as hormonal therapy were eligible.
9. Cardiac ejection fraction ≥ 50% assessed by echocardiography or MUGA.
10. Eligible to receive intensive chemotherapy.
11. Female patients of child-bearing potential must have a negative serum pregnancy test at screening and agree to use reliable methods of contraception for three months after their last dose of medication. Male patients must use a reliable method of contraception (if sexually active with a female of child-bearing potential).
12. Willingness and ability to comply with scheduled visits, treatment plans, laboratory tests and other study procedures

Exclusion Criteria:

1. Patients with genetic diagnosis of acute promyelocytic leukemia.
2. Age \<60 years or \>75 years.
3. Blastic phase of bcr/abl chronic myeloid leukemia.
4. Patients with de novo AML without FISH or cytogenetic changes linked to MDS per WHO 2016 criteria.
5. Clinical evidence of active central nervous system (CNS) leukemia.
6. Subjects with active (uncontrolled, metastatic) second malignancies.
7. Any major surgery or radiation therapy in 4 weeks.
8. Subjects with myocardial impairment of any cause (eg, cardiomyopathy, ischemic heart disease, significant valvular dysfunction, hypertensive heart disease, and congestive heart failure) resulting in heart failure by New York Heart Association Criteria (Class III or IV staging).
9. Uncontrolled infection; subjects with an infection receiving treatment (antibiotic, antifungal, or antiviral treatment) could be entered into the study provided the subject was respiratory and hemodynamically stable for ≥ 72 hours.
10. Current evidence of invasive fungal infection (blood or tissue culture); subjects with recent fungal infection must have had subsequent negative cultures to be eligible; known HIV (new testing not required) or evidence of active hepatitis B or C infection (with rising transaminase values).
11. Hypersensitivity to cytarabine, daunorubicin or liposomal products.
12. Presence of any severe psychiatric disease or physical condition that, according to the physician´s criteria, contraindicates the inclusion of the patient into the clinical trial.
13. Serum creatinine ≥ 20 mg/dL (unless it is attributable to AML activity).
14. Bilirubin, alkaline phosphatase, or SGOT \> 3 times the ULN (unless it is attributable to AML activity).
15. Subjects with prior cumulative anthracycline exposure of greater than 368 mg/m2 daunorubicin (or equivalent).
16. History of Wilson's disease or other copper-metabolism disorder.
17. Patients who have received an investigational agent (for any indication) within 5 half-lives of the agent and until toxicity from this has resolved to grade 1 or less; if the half-life of the agent is unknown, patients must wait 4 weeks prior to first dose of study treatment.