New strategy aims to boost chemo power in childhood leukemia

Copied word for word from the study's registry entry, so the wording is the study team's rather than ours.

INCLUSION CRITERIA: * Diagnostic criteria: Patients must have one of the following diagnoses: * Acute myeloid leukemia fulfilling the criteria of the WHO Classification (see Appendix I), or * \>5% but \< 20% marrow myeloblasts and evidence of a clonal de novo AML genetic abnormality \[e.g., t(8;21), inv(16), t(9;11)\], or * Myeloid sarcoma (also referred to as extramedullary myeloid tumor, granulocytic sarcoma, or chloroma), with or without evidence of a leukemia process in the bone marrow or peripheral blood, with confirmation of myeloid differentiation, or * High grade myelodysplastic syndrome (MDS) with greater than 5% blasts, or * Patients with treatment related myeloid neoplasms including AML and MDS, provided their cumulative anthracycline dose has not exceeded 230 mg/m2 doxorubicin equivalents. * Other criteria - Patients must meet all the following criteria: * Age \> 28 days and \< 22 years at time of study entry inclusive, and * No prior therapy for this malignancy except for one dose of intrathecal therapy and the use of hydroxyurea or low-dose cytarabine (100-200 mg/m2 per day for one week or less for hyperleukocytosis), and * Written informed consent according to institutional guidelines, and * Female patients of childbearing potential must have a negative pregnancy test within 2 weeks prior to enrollment, and * Male and female participants of reproductive potential must use an effective contraceptive method during the study and for a minimum of 6 months after study treatment. EXCLUSION CRITERIA: * Down syndrome * Acute promyelocytic leukemia (APL) * BCR-ABL1 chronic myeloid leukemia in blast crisis (CML-BC) * Juvenile myelomonocytic leukemia (JMML) * Fanconi anemia (FA) * Kostmann syndrome * Shwachman syndrome * Other bone marrow failure syndromes or low grade (\<5% bone marrow blasts) MDS. * Use of concomitant chemotherapy, radiation therapy, or immunotherapy other than as specified in the protocol. * Use of investigational agents within 30 days or any anticancer therapy for this malignancy within 2 weeks before study entry with the exception of IT therapy, hydroxyurea, or low-dose cytarabine as specified in the protocol document. The patient must have recovered from all acute toxicities from any previous therapy. * Systemic fungal, bacterial, viral, or other infection not controlled (defined as exhibiting ongoing signs/symptoms related to the infection and without improvement, despite appropriate antibiotics or other treatment). * Pregnant or lactating. * Any significant concurrent disease, illness, or psychiatric disorder that would compromise patient safety or compliance, interfere with consent, study participation, follow up, or interpretation of study results. * Prior chemotherapy, with the exception of hydroxyurea or low-dose cytarabine as specified in the protocol document. The patient must have recovered from all acute toxicities from any previous therapy. * Patients with treatment related myeloid neoplasms with cumulative anthracyclines greater than 230 mg/m2 doxorubicin equivalents.