Pharmacokinetic and Pharmacodynamic Assessment of Treatment With CPX-351 (Cytarabine: Daunorubicin) Liposome for Injection in Acute Leukemias and MDS Patients With Moderate Hepatic Impairment

Inclusion Criteria:

- Ability to understand and voluntarily sign an informed consent form

- Age ≥ 18 to ≤ 80 years at the time of signing the informed consent form

- Life expectancy of at least 3 months

- Pathological confirmation by bone marrow documenting the following:

- Newly Diagnosed De novo AML according to WHO criteria except for Acute
Promyelocytic Leukemia or patients with known favorable cytogenetics

- Newly Diagnosed Secondary AML defined as having a history of an antecedent
hematologic disorder (myelodysplastic syndromes [MDS], myeloproliferative disease
[MPD]or history of cytotoxic treatment for non-hematologic malignancy)

- Patients with relapsed/refractory AML regardless of cytogenetic risk

- Patients with relapsed/refractory ALL

- Patients with MDS (IPSS score ≥ 1.5)

- Eastern Cooperative Oncology Group (ECOG) performance status score of 0-2

- Able to adhere to the study visit schedule and other protocol requirements

- Laboratory values fulfilling the following:

- Serum creatinine ≤ 2.0mg/dL.

- Hepatic function with a score of 7-9 points according to the Child-Pugh System

- Serum alanine aminotransferase or aspartate aminotransferase < 3 times the ULN.
Note:If elevated liver enzymes are related to disease; contact medical monitor to
discuss.

- Cardiac ejection fraction ≥50% by ECHO or MUGA

- Patients with second malignancies in remission may be eligible if there is clinical
evidence of disease stability for a period of greater than 6 months off cytotoxic
chemotherapy, documented by imaging, tumor marker studies, etc., at screening.
Patients maintained on long-term nonchemotherapy treatment, e.g., hormonal therapy,
are eligible.

- All men and women must agree to practice effective contraception during the study
period if not otherwise documented to be infertile.

Exclusion Criteria:

- Patients with history of and/or current evidence of myocardial impairment (e.g.
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)

- Newly diagnosed patients with Acute promyelocytic leukemia [t(15;17)] or favorable
cytogenetics, including t(8;21) or inv16

- Clinical evidence of active CNS leukemic involvement

- Chemotherapy or other investigational anticancer therapeutic drugs within 1 week prior
to study entry. AEs from prior therapy must have resolved or stabilized so that there
is no interference with the assessment of efficacy or safety; in the event of rapidly
proliferative disease, however, the use of hydroxyurea is permitted up to 12 hours
before study entry. Patients with prior bone marrow or stem cell transplant,
considered for inclusion, should be discussed with the medical monitor first.

- Any serious medical condition or psychiatric illness that would prevent the patient
from providing informed consent

- Patients with prior cumulative anthracycline exposure of greater than 368 mg/m2
daunorubicin (or equivalent)

- Active or uncontrolled infection. Patients with any infection receiving treatment
(antibiotic,antifungal or antiviral treatment) may be entered into the study but must
be afebrile and hemodynamically stable for ≥72 hrs. Patients with fevers believed to
be due to leukemia or MDS are eligible provided a thorough infection work-up is
negative and the patient is clinically and hemodynamically stable.

- Pregnant or lactating women

- Hypersensitivity to cytarabine, daunorubicin or liposomal products

- History of Wilson's disease or other copper-related metabolic disorder