Genomic Predictors of Decitabine Response in Patients With Acute Myeloid Leukemia or Myelodysplastic Syndromes

Inclusion Criteria: All of the following: * Patient must have non-M3 AML or MDS * An adverse risk karyotype defined by: * Complex karyotype by cytogenetics, or * Deletion of all or part of chromosome 5, 7, 12, or 17 defined by FISH or cytogenetics, or * Somatic TP53 mutation All of the following: 1. Patient must have an ECOG performance status ≤ 2. 2. Patient must have \>10% disease burden measured by cytomorphology, flow cytometry, or cytogenetics. 3. Patient must have peripheral white blood cell count \< 50,000/mcl. 4. Patient must have adequate organ function, defined as: 1. Total bilirubin \< 1.5 x ULN 2. AST/ALT \< 2.5 x ULN 3. Serum creatinine \< 2.0 x ULN 5. Patient must have undergone ≤ 2 cycles of prior hypomethylating agent (decitabine or azacitidine). 6. Patient must be enrolled in HRPO# 201011766 ("Tissue Acquisition for Analysis of Genetic Progression Factors in Hematologic Diseases"). 7. Patient must be \> 18 years of age. 8. Patient must be able to understand and willing to sign an IRB-approved written informed consent document. Exclusion Criteria: * Patient must not be pregnant or nursing * Patient must not have acute promyelocytic leukemia or t(15;17) observed by FISH. * Patient must not have known central nervous system (CNS) leukemia * Patient must not have a history of positive human immunodeficiency virus (HIV) serology * Patient must not have a history of positive hepatitis C serology * Patient must not have undergone prior allogeneic stem cell transplant * Patient must not have any uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, ongoing or active graft-versus-host disease (GVHD), congestive heart failure of New York Heart Association (NYHA) class 3 or 4, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situation that would limit compliance with study requirements * Patient must not have had radiation therapy within 14 days of enrollment * Patient must not have received any chemotherapy within 21 days of enrollment and any acute treatment-related toxicities must have returned to baseline. Patients may be receiving hydrea at time of enrollment.