Originele protocol

Inclusion criteria

 Patients eligible for standard chemotherapy.
 Patients 66 years and older 
 Patients with a diagnosis of AML and related precursor neoplasms according to WHO 2008 classification (excluding acute promyelocytic leukemia) including secondary AML (after an antecedent hematological disease (e.g. MDS) and therapy-related AML, or acute leukemia’s of ambiguous lineage according to WHO 2008 or a diagnosis of refractory anemia with excess of blasts (MDS) and IPSS-R > 4.5 
 Adequate renal and hepatic functions unless clearly disease related as indicated by the following laboratory values:
Serum creatinine ≤1.0 mg/dL (≤88.7 µmol/L); if serum creatinine >1.0 mg/dL (>88.7 µmol/L), then the estimated glomerular filtration rate (GFR) must be >60 mL/min/1.73 m2 as calculated by the Modification of Diet in Renal Disease equation where the Predicted GFR (ml/min/1.73 m2) = 186 x (Serum Creatinine in mg/dL)-1.154 x (age in years)-0.203 x (0.742 if patient is female) x (1.212 if patient is black)
NOTE: if serum creatinine is measured in µmol/L, recalculate it in mg/dL according to the equation: 1 mg/dL = 88.7 µmol/L and use the above mentioned formula.
Serum bilirubin ≤ 2.5 x upper limit of normal (ULN)
Aspartate transaminase (AST) ≤ 2.5 x ULN
Alanine transaminase (ALT) ≤ 2.5 x ULN
Alkaline phosphatase ≤ 2.5 x ULN
 WHO performance status 0, 1 or 2 (see Appendix F)
 Written informed consent.
 Male and female patients must use an effective contraceptive method during the study and for a minimum of 6 months after study treatment.

Exclusion criteria

 Acute promyelocytic leukemia
 Patients previously treated for AML (any antileukemic therapy including investigational agents), a short treatment period (< 2 weeks) with Hydroxyurea is allowed
 Concurrent history of active malignancy in the two past years prior to diagnosis except for: 
Basal and squamous cell carcinoma of the skin
In situ carcinoma of the cervix
Blast crisis of chronic myeloid leukemia 
 Concurrent severe and/or uncontrolled medical condition (e.g. uncontrolled diabetes, infection, hypertension, pulmonary disease etcetera)
 Cardiac dysfunction as defined by myocardial infarction within the last 6 months of study entry, or reduced left ventricular function with an ejection fraction < 50% ad measured by MUG scan or echocardiogram or unstable angina or New York Heart Association (NYHA) grade II or greater congestive heart failure (see Appendix I) or unstable cardiac arrhythmias
 Patients with a history of non-compliance to medical regimens or who are considered unreliable with respect to compliance
 Patients with any serious concomitant medical condition which could, in the opinion of the investigator, compromise participation in the study.
 Patients who have senile dementia, mental impairment or any other psychiatric disorder that prohibits the patient from understanding and giving informed consent.
 Current concomitant chemotherapy, radiation therapy, or immunotherapy other than as specified in the protocol.
 Any psychological, familial, sociological and geographical condition potentially hampering compliance with the study protocol and follow-up schedule