Inclusion Criteria-Do not admit the patient to this study if any "No" box has been marked
Written informed consent
boolean
Age
boolean
a)Diagnosis of myelodysplastic syndrome, subcategories of refractory anemia with excess of blasts, INT 2 or high risk (RAEB) as defined by Greenberg, et al, [4] (see protocol Appendix L), or refractory anemia with excess of blasts in transformation (RAEB-t) OR b)Diagnosis of AML which has evolved from a preceding phase of MDS defined as the presence of antecedent hematologic disorder existing for at least the past three months, AML and/or poor prognosis cytogenetics.
boolean
Performance status <= 2 (Zubrod-ECOG-WHO cale, protocol Appendix C) and life expectancy =>6 weeks.
boolean
Patients must not have received prior chemotherapy except low-dose ara-C, hydroxyurea, or intrathecal methotrexate for MDS or AML.
boolean
Recovery from all toxicities since last chemotherapy and/or biologic therapy, unless specific conditions discussed with medical monitor.
boolean
Patients with previous malignancies in CR for one year or greater.
boolean
Patients must not be candidates for curative allogenic bone marrow transplant at the time of treatment, although it is recognized they may become candidates at a future time (i.e., a matched donor is found).
boolean
Current laboratory values within the limits listed below unless agreed upon by the principal investigator and the medical monitor: - creatinine <= 1.5 mg/dL (133 micromol/l) - serum bilirubin <= 2.0 mg/dL (34 micromol/l) SGOT/SGPT <= 2 times the upper limit of normal
boolean
Patients must have a left ventricular ejection fraction (LVEF) of at least 50%
boolean
Exclusion Criteria-Do not admit the patient to this study if any "Yes" box has been marked
Patients who are eligible for curative allogenic bone marrow transplant without additional treatment.
boolean
Patients with chromosomal abnormalities of t(15;17), t(8;21), or inv(16)
boolean
Patients with CMML.
boolean
Less than 3 weeks since major surgery, except for placement of central line.
boolean
Concomitant malignancies with the exception of curatively treated basal cell carcinoma of the skin, carcinoma in situ of the cervix and previous malignancies in CR for less than one year.
boolean
Concurrent severe medical problems unrelated to the malignancy which would significantly limit the full compliance with the study or expose the patient to extreme risk.
boolean
Uncontrolled or severe cardiovascular disease including recent (< 3 months) myocardial infarction or congestive heart failure.
boolean
Active infection
boolean
Patients who have a history of (+) HIV.
boolean
Patients who have (+) PPD with abnormal CXR
boolean
Females of child-bearing potential, not practicing adequate contraception. Females of child-bearing potential, premenopausal (less than 60 years of age), or not surgically sterilized must use effective contraception by barrier method contraception, an interuterine device (IUD) or use of birth control pill for 3 months prior to entry into the study and agree to continue to use it during the study and for at least 4 weeks after the end of study drug administration.
boolean
Pregnancy or lactation.
boolean
Use of an investigational drug (including a cytotoxic drug) within 30 days or 5 half-lives (whichever is longer) preceding the first dose of study medication.
boolean
Concurrent use of other chemotherapy
boolean
Any chemotherapy with topotecan or idarubicin
boolean
History of hypersensitivity to compounds chemically related to topotecan, ara-C, idarubicin or G-CSF.
boolean
Patient known to be refractory to "platelet transfusions."
boolean
Telephone Randomisation
If Yes to Telephone Randomisation