Inclusion Criteria:

- Documented diagnosis of MDS, or CMML with WBC < 13,000/mm3 that meets IPSS criteria
for intermediate-2 or high-risk disease,

- IPSS score ≥1.5

- Myocardial function does not indicate cons the use of idarubicin no contra indication
to anthracyclines

- Age ≥ 18 years

- Perfornance Status ≤2 according to ECOG.

- Serum creatinine < 1.5 x ULN and normal levels of electrolytes (serum sodium 136-145
nmmol/l, Potassium 3,5-4,5 mmol/l, alkaline Reserve 23-29 mmol/l, , Calcium 2,15-2,5
mmol/l, Phospohore 0,87-1,45 mmol/l) Serum aspartate aminotransferase (AST)/serum
glutamic-oxaloacetic transaminase (SGOT) or alanine transaminase (ALT)/serum
glutamate pyruvate transaminase (SGPT) < 1.5 x upper limit of normal (ULN)

- Serum total bilirubin < 1.5 x ULN.

- Must be able to adhere to the study visit schedule and other protocol requirements

- Signed informed consent.

Female subjects of childbearing potential† must:

• Accept effective contraception without interruption throughout the duration of study and
up to three months after the end of treatment.

Male subjects must

- Agree to use condoms throughout study drug therapy, during any dose interruption and
for one week after cessation of study therapy and up to three months after the final
treatment if their partner is of childbearing potential and has no contraception.

- Agree to learn the procedures for preservation of sperm

Exclusion Criteria:

- Uncontrolled infection

- Prior therapy with anthracycline for MDS.

- Eligible for an allogeneic stem cell transplantation.

- Prior therapy with demethylating agents within the last 3 months

- Prior therapy with Hematopoietic growth factor (ESA or G-CSF) agents or cytotoxic
agents (oral chemotherapy, low doses AraC) within the last 30 days.

- Prior history of malignancy other than MDS (except basal cell or squamous cell
carcinoma or carcinoma in situ of the cervix or breast)

- Pregnant or lactating females

- Known HIV-1 positivity

- Contra-indication to Anthracyclines