Combination Chemotherapy in Treating Young Patients With Down Syndrome and Acute Myeloid Leukemia or Myelodysplastic Syndromes

Inclusion Criteria:

   - Diagnosis DS or DS mosaicism by karyotype or chromosomal analysis

   - Diagnosis of myelodysplastic syndromes (MDS) with < 30% blasts or acute myeloid
   leukemia (AML)

      - Newly diagnosed disease

   - Patients with a history of transient myeloproliferative disorder (TMD) are eligible
   provided the patient is diagnosed with AML or MDS at > 90 days of age AND meets either
   of the following criteria:

      - At least 30% blasts in the bone marrow regardless of time since resolution of TMD

      - More than 8 weeks since resolution of TMD with ≥ 5% blasts in the bone marrow

   - Immunophenotype required for study entry

   - No promyelocytic leukemia

   - Shortening fraction ≥ 27% by echocardiogram OR ejection fraction ≥ 50% by radionuclide
   angiogram

   - Bilirubin ≤ 1.5 times upper limit of normal (ULN)

   - AST or ALT < 2.5 times ULN

   - Creatinine adjusted according to age as follows:

      - No greater than 0.4 mg/dL (≤ 5 months)

      - No greater than 0.5 mg/dL (6 months -11 months)

      - No greater than 0.6 mg/dL (1 year-23 months)

      - No greater than 0.8 mg/dL (2 years-5 years)

      - No greater than 1.0 mg/dL (6 years-9 years)

      - No greater than 1.2 mg/dL (10 years-12 years)

      - No greater than 1.4 mg/dL (13 years and over [female])

      - No greater than 1.5 mg/dL (13 years to 15 years [male])

      - No greater than 1.7 mg/dL (16 years and over [male])

   - Creatinine clearance or radioisotope glomerular filtration rate at least 70 mL/min

   - No evidence of dyspnea at rest

   - No exercise intolerance

   - Pulse oximetry > 94%

   - No prior chemotherapy, radiotherapy, or any antileukemic therapy

      - Intrathecal cytarabine therapy given at diagnosis allowed

   - Prior therapy for TMD allowed