Dose Escalation, Safety and Pharmacokinetic Study of SAR103168 in Patients Refractory/ Relapsed Acute Leukemias or High-risk Myelodysplastic Syndromes

Primary objectives:

* To determine the maximum tolerated dose (MTD) of SAR103168 and to characterize the dose limiting toxicities (DLTs) in the proposed dose regimen
* To evaluate the pharmacokinetic (PK) profile of SAR103168

Secondary objectives:

* To characterize the global safety profile of SAR103168
* To evaluate preliminary anti-leukemia activity
* To investigate the potential induction effect on CYP3A4 and persistence of this effect by using oral midazolam as a probe substrate in patients enrolled into the expanded cohort at the MTD
* To determine the metabolic pathways of SAR103168 and identify the chemical structures of metabolites
* To determine the potential impact of SAR103168 on the QTc interval in patients enrolled at the MTD

Patients will receive the study drug until unacceptable toxicity, clinically significant disease progression, withdrawal of consent or investigator's decision, and for a maximum of 1 year.

Eligibility Criteria:
Inclusion Criteria:

* Patients with refractory/relapsed acute leukemias or high-risk myelodysplastic syndromes with no curative option available including any of the following:

  * Patients with de novo or secondary acute myelogenous leukemia (AML) (except acute promyelocytic leukemia), meeting one of the following conditions:
  * Refractory or relapsed AML; In case of first relapse the CR duration should be less than 12 months. If the relapse failed at least one prior salvage attempt, the CR duration may be more than 12 months.
  * Into the expanded cohort at the MTD, previously untreated AML patients over age 60 with poor- risk cytogenetics who are not eligible for or do not accept induction chemotherapy may also be included.
* Patients with refractory/relapsed acute lymphoblastic leukemia (ALL)
* Patients with high-risk myelodysplastic syndrome (MDS) as defined by the International Prognostic Scoring System
* Patients with chronic myeloid leukemia in blast phase (CML-BP)

Exclusion Criteria:

* performance status \> 2
* Active uncontrolled central nervous system leukemia
* Cytotoxic therapy within 2 weeks prior to the first dose of SAR103168. For the non cytotoxic agents/investigational drugs this washout period should be at least 2 weeks or at least 5 half-lives whichever is longer. Hydroxyurea must be stopped at least 24 hours prior to the first dose of SAR103168
* Lack of recovery from toxicities from prior therapies to grade \< 1
* White blood cells \> 30 x 10\^9/L prior to the first dose of SAR103168
* Prior allogeneic stem cell transplantation or donor lymphocytes infusion within 3 months preceding the first dose of SAR103168
* Any of the following within 6 months prior to the first dose of SAR103168:

  * Myocardial infarction, congestive heart failure, documented angina pectoris, arrhythmia requiring medication (in particular atrial fibrillation or flutter), severe conduction disorder (second or third atrio-ventricular block, pacemaker), coronary/peripheral artery bypass graft surgery
  * Arterial or venous thromboembolism, deep venous thrombosis
* Left ventricular ejection fraction \< 50% by echocardiography or multiple gated acquisition scan
* Cardiac ischemia on 12-lead ECG
* Baseline QTc-interval \> 500 msec
* Hypertension uncontrolled with appropriate therapy
* Active infection (viral, bacterial or fungal) uncontrolled with appropriate therapy
* Major surgery within 6 weeks prior to the first dose of SAR103168
* Poor organ function defined by one of the following:

  * Total bilirubin \> 1.5 x upper limit of normal (ULN) unless related to leukemia (i.e. hemolysis) or Gilbert's syndrome
  * Aspartate aminotransferase (AST), alanine aminotransferase (ALT) \> 2.5 x ULN
  * Serum creatinine \> 1.5 x ULN or calculated creatinine clearance \< 50 mL/min
* Patients under treatment with potent inhibitors of CYP3A4 unless these treatments may be stopped at least 3 days prior to the first dose of SAR103168
* Patients under treatment with CYP3A4 or CYP2C9 inducers, unless these treatments may be stopped at least 3 days prior to the first dose of SAR103168
* Pregnant or breast-feeding women or refusal to use adequate contraceptive method, when applicable.