Investigator Initiated Trial of CPX-351 for Untreated Acute Myeloid Leukemia

Inclusion Criteria:

- Ability to understand and voluntarily give informed consent

- Age≥60 years at the time of study treatment

- Pathological diagnosis of AML according to WHO criteria (with >20% blasts in the
peripheral blood or bone marrow) including:

- De novo AML with normal karyotype or adverse karyotypes (including patients with
karyotypic abnormalities characteristic of MDS)

- Secondary AML: transformed from prior MDS or MPN, confirmed by bone marrow
documentation of prior antecedent hematologic disorder

- Therapy-related AML: t-AML, requires documented history of prior cytotoxic therapy or
ionizing radiotherapy for an unrelated disease

- Performance status >50% KPS, ECOG 0-2

- Laboratory values fulfilling the following:

- Serum creatinine < 2.5 mg/dL

- Serum total bilirubin < 2.5 mg/dL,

- Serum alanine aminotransferase or aspartate aminotransferase < 3 times the ULN

- Patients with elevated liver enzymes and serum creatinine values secondary to AML are
eligible after discussion with PI

- Cardiac ejection fraction ≥ 50% by echocardiography or MUGA

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

Exclusion Criteria:

- Acute promyelocytic leukemia [t(15;17)]

- Clinical evidence of active CNS leukemia

- Prior intensive chemotherapy for AML with anthracycline/cytarabine-based regimens and/
or prior HSCT. Patients may have been treated with commercially available or
investigational hypomethylating agents (e.g. decitabine, azacitidine, SGI-110),
lenalidomide, or low-dose cytarabine (not to exceed 20 mg/m2 daily for 14 days for ≤ 6
cycles)

- Prior treatment including HMA, systemic chemotherapy, surgery, or radiation therapy
must have been completed at least 7 days before start of study treatment or after
discussion with PI. Treatment with investigational agents must have been completed at
least 14 days prior to study drug treatment. Hydroxyurea is permitted for control of
blood counts before the start of study treatment. Toxicities associated with prior
therapies must have recovered to grade 1 or less prior to start of study treatment.

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

- Any serious medical condition, laboratory abnormality or psychiatric illness that
would prevent obtaining informed consent

- Patients with myocardial impairment of any cause (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)

- Active or uncontrolled infection. Patients with an 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 current or recent evidence of invasive fungal infection (blood or tissue
culture); patients with recent fungal infection must have a 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)

- Hypersensitivity to cytarabine, daunorubicin or liposomal products

- History of Wilson's disease or other copper-metabolism disorder

- History of prior bone marrow or solid organ transplantation