Amonafide in Combination With Cytarabine in Secondary AML

Inclusion Criteria: * Histologic diagnosis of AML (≥20% blasts of myeloid lineage in bone marrow), with FAB classification other than M3, secondary to either: 1. Known and documented exposure to prior leukemogenic chemotherapy or radiotherapy, OR 2. Diagnosis of MDS for ≥3 months prior to study entry (prior BM slides documenting MDS must be available for central pathology review). * Age 18 years or older. * ECOG performance status ≤2. * No prior induction chemotherapy for AML; at least 4 weeks since completion of prior chemotherapy for MDS. (Subjects with rapidly rising blast count may be enrolled within 4 weeks of prior cytotoxic chemotherapy). * Fertile and sexually active men and women must use effective contraception throughout study. Women of childbearing potential must have a negative pregnancy test. * LVEF ≥50% by MUGA or ECHO. * Adequate renal function: serum creatinine ≤1.5 x ULN. * Adequate hepatic function: total serum bilirubin ≤1.5 x ULN as well as serum AST and ALT ≤1.5 x ULN. * Subject must be able to participate fully in all aspects of the trial. * Subject must give voluntary, written consent and HIPAA authorization (US only). Exclusion Criteria: * Histologic diagnosis of FAB M3 AML (acute promyelocytic leukemia). * Clinically active CNS leukemia. * Known to be HIV positive. * Prior induction chemotherapy for AML. * Known active hepatitis B or C or other active liver disease. * Any major surgery or radiation therapy within 4 weeks prior to study entry. * Prior cytotoxic chemotherapy within 4 weeks prior to study entry.(Subjects with rapidly rising blast count may be enrolled within 4 weeks of prior cytotoxic chemotherapy). * Persistent chronic non-hematologic toxicity from prior chemotherapy (other than alopecia) that is \> than grade 1. * Serious concomitant illness (e.g., active pulmonary infection, unstable angina or myocardial infarction within 3 months of study entry, congestive heart failure ≥AHA class 2, stroke within 3 months prior to study entry, uncontrolled hypertension, uncontrolled diabetes, actively bleeding gastric ulcer, etc.). * Women who are pregnant or lactating. * History of clinically significant allergic reactions attributed to compounds similar to amonafide or cytarabine. * Prior enrollment on this trial. * Any other known condition (familial, sociological, or geographic) or behavior (including substance abuse, psychological or psychiatric illness), which in the investigator's opinion would make the subject a poor candidate for this trial.