| E.1 Medical condition or disease under investigation | 
| E.1.1 | Medical condition(s) being investigated |  | 
| E.1.1.1 | Medical condition in easily understood language |  | 
| E.1.1.2 | Therapeutic area | Diseases [C] - Cancer [C04] | 
| MedDRA Classification | 
| E.1.2 Medical condition or disease under investigation | 
| 
| E.1.2 | Version | 20.0 |  
| E.1.2 | Level | LLT |  
| E.1.2 | Classification code | 10060558 |  
| E.1.2 | Term | Acute myeloid leukemia recurrent |  
| E.1.2 | System Organ Class | 100000012987 |  | 
| E.1.3 | Condition being studied is a rare disease | Yes | 
| E.2 Objective of the trial | 
| E.2.1 | Main objective of the trial | 
| To determine a safe and tolerable dose of CPX-351 in children and adolescents with relapsed or refractory hematopoietic malignancies and to recommend a dose for future studies. |  | 
| E.2.2 | Secondary objectives of the trial | 
| To estimate the overall response rate to a single course of CPX-351 to young patients with recurrent or refractory hematologic malignancies.
 |  | 
| E.2.3 | Trial contains a sub-study | No | 
| E.3 | Principal inclusion criteria | 
| - Age 1-21 yrs at the time of study enrollment - Diagnosis of a hematologic malignancy [acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), or aggressive lymphoma]
 - Karnofsky ≥ 50% for patients > 16 years of age and Lansky ≥ 50 for patients ≤16 years of age
 - Patients must have fully recovered from acute toxicities of prior therapy
 - Adequate Organ Function requirements, defined as:
 o Platelet count ≥ 20 X 109/L (20,000/mcgL) (may receive platelet transfusion)
 o Hemoglobin ≥ 8.0 g/dL (may receive RBC transfusion)
 o Adequate serum creatinine based on age/gender or a 24 hour creatinine clearance/ radioisotope determined GFR ≥ 70mL/min/1.73 m2
 o Direct bilirubin ≤ 1.5 X upper limit of normal (ULN) for age
 o SGPT (ALT) , 5.0 X ULN for age and institution (unless elevation is related to leukemia involvement)
 o Shortening fraction of ≥27% by echocardiogram, or Ejection fraction of ≥ 50% by gated radionuclide study or echocardiogram
 |  | 
| E.4 | Principal exclusion criteria | 
| - Patients with Acute Promyelocytic Leukemia (APML), Down Syndrome, Fanconi Anemia, ALL and CNS leukemia (CNS status 3). - Pregnant or breast-feeding women and males or females of reproductive potential unwilling to use an effective contraceptive method.
 - Growth factors that support platelet or white cell number or function must not have been administered within the 7 days prior to enrollment.
 - Patients who are currently receiving another investigational drug or anti-cancer agents (with the exception of intrathecal cytarabine and oral hydroxyurea. Hydroxyurea must be discontinued 24 hours prior to initiation of protocol therapy).
 - Patients who have an uncontrolled infection, history of Wilson’s disease or other copper metabolism, had major surgery within 4 weeks of enrollment or received prior radiation to the mediastinum.
 - Patients who in the opinion of the investigator may not be able to comply with the safety monitoring requirements of the study.
 |  | 
| E.5 End points | 
| E.5.1 | Primary end point(s) | 
| ● Determine rate of dose limiting toxicities ● Number of participants with dose limiting toxicities to determine maximum tolerated dose
 ● Pharmacokinetics: Serum concentration of CPX-351 components and metabolites
 
 |  | 
| E.5.1.1 | Timepoint(s) of evaluation of this end point | 
| ● Day 56 ● Day 56
 ● Day 10
 |  | 
| E.5.2 | Secondary end point(s) | 
| ● Overall response rate after a single course of CPX-351 ● Electrocardigram, echocardiogram, peripheral blood cardiac troponin-T (cTn-T) and brain natriuretic peptide (BnP)
 |  | 
| E.5.2.1 | Timepoint(s) of evaluation of this end point |  | 
| E.6 and E.7 Scope of the trial | 
| E.6 | Scope of the trial | 
| E.6.1 | Diagnosis | No | 
| E.6.2 | Prophylaxis | No | 
| E.6.3 | Therapy | Yes | 
| E.6.4 | Safety | Yes | 
| E.6.5 | Efficacy | Yes | 
| E.6.6 | Pharmacokinetic | Yes | 
| E.6.7 | Pharmacodynamic | No | 
| E.6.8 | Bioequivalence | No | 
| E.6.9 | Dose response | No | 
| E.6.10 | Pharmacogenetic | No | 
| E.6.11 | Pharmacogenomic | No | 
| E.6.12 | Pharmacoeconomic | No | 
| E.6.13 | Others | No | 
| E.7 | Trial type and phase | 
| E.7.1 | Human pharmacology (Phase I) | Yes | 
| E.7.1.1 | First administration to humans | No | 
| E.7.1.2 | Bioequivalence study | No | 
| E.7.1.3 | Other | Yes | 
| E.7.1.3.1 | Other trial type description |  | 
| E.7.2 | Therapeutic exploratory (Phase II) | No | 
| E.7.3 | Therapeutic confirmatory (Phase III) | No | 
| E.7.4 | Therapeutic use (Phase IV) | No | 
| E.8 Design of the trial | 
| E.8.1 | Controlled | No | 
| E.8.1.1 | Randomised | No | 
| E.8.1.2 | Open | Yes | 
| E.8.1.3 | Single blind | No | 
| E.8.1.4 | Double blind | No | 
| E.8.1.5 | Parallel group | No | 
| E.8.1.6 | Cross over | No | 
| E.8.1.7 | Other | No | 
| E.8.2 | Comparator of controlled trial | 
| E.8.2.1 | Other medicinal product(s) | No | 
| E.8.2.2 | Placebo | No | 
| E.8.2.3 | Other | No | 
| E.8.3 | Will this trial be conducted at a single site globally? | Yes | 
| E.8.4 | Will this trial be conducted at multiple sites globally? | No | 
| E.8.6 Trial involving sites outside the EEA | 
| E.8.6.2 | Trial being conducted completely outside of the EEA | Yes | 
| E.8.6.3 | Specify the countries outside of the EEA in which trial sites are planned |  | 
| E.8.7 | Trial has a data monitoring committee | No | 
| E.8.8 | Definition of the end of the trial and justification where it is not the last
                        visit of the last subject undergoing the trial |  | 
| E.8.9 Initial estimate of the duration of the trial | 
| E.8.9.2 | In all countries concerned by the trial years | 5 |