Atovaquone in combination with Conventional Chemotherapy in Treating Children, Adolescents, and Young Adults with Newly Diagnosed or Untreated Acute Myeloid Leukemia

Inclusion Criteria

• Patients must be newly diagnosed with acute myelogenous leukemia
• Patients with previously untreated primary AML who meet the customary criteria for AML with >= 20% bone marrow blasts as set out in the 2008 World Health Organization (WHO) Myeloid Neoplasm Classification are eligible * Attempts to obtain bone marrow either by aspirate or biopsy must be made unless clinically prohibitive. In cases where it is clinically prohibitive, peripheral blood with an excess of 20% blasts and in which adequate flow cytometric and cytogenetics/fluorescence in situ hybridization (FISH) testing is feasible can be substituted for the marrow exam at diagnosis
• Patients with < 20% bone marrow or peripheral blood blasts are eligible if they have: * A karyotypic abnormality characteristic of de novo AML (t(8;21)(q22;q22), inv(16)(p13q22) or t(16;16)(p13;q22) or 11q23) abnormalities * The unequivocal presence of megakaryoblasts, or * Biopsy proven isolated myeloid sarcoma (myeloblastoma; chloroma, including leukemia cutis)
• Patients with a history of myelodysplastic syndrome that has progressed to AML which meets the criteria above are eligible
• Patients with AML which is thought to be therapy related but meet the criteria above are eligible
• Prior therapy with hydroxyurea, all-trans retinoic acid (ATRA), corticosteroids (any route), and intrathecal (IT) cytarabine given at diagnosis is allowed. Hydroxyurea and ATRA cannot be given concurrently with protocol therapy. There is no specific amount of time mandated between the last dose of hydroxyurea or ATRA and the start of protocol therapy * With the exception of infants who had previously received low dose cytarabine to control disease, patients who have previously received any other antileukemic therapy (i.e. chemotherapy or radiation therapy) are not eligible for this protocol
• Direct bilirubin =< 2 x upper limit of normal (ULN) for age and institution (unless related to leukemic involvement), and
• Serum glutamate pyruvate transaminase (SGPT) (alanine aminotransferase [ALT]) and serum glutamic oxaloacetic transaminase (SGOT) (aspartate aminotransferase [AST]) =< 2.5 x ULN for age and institution (unless it is related to leukemic involvement)
• Eligible patients should have no contraindication to enteral administration of medication (e.g. oral, nasogastric [NG], administration via gastrostomy [G-tube], etc) as determined by the evaluating physician
• All patients and/or their parents or legally authorized representatives must sign a written informed consent. Assent, when appropriate, will be obtained according to institutional guidelines

Exclusion Criteria

• Patients with a history of any of the following constitutional conditions are not eligible: * Fanconi anemia * Shwachman syndrome * Any other known constitutional bone marrow failure syndrome * Patients with constitutional trisomy 21 or with constitutional mosaicism of trisomy 21 who are eligible to receive treatment for down syndrome (DS) related AML * Note: Enrollment and initiation of therapy may occur pending results of clinically indicated studies to exclude these conditions. If a patient is found to have any of these conditions they should be removed from the study once results are received. Patients who are removed due to ineligibility after results are received will be replaced
• Patients with any of the following oncologic diagnoses are not eligible: * Any concurrent malignancy * Juvenile myelomonocytic leukemia (JMML) * Philadelphia chromosome positive AML * Biphenotypic or bilineal acute leukemia * Acute promyelocytic leukemia * Note: Enrollment and initiation of therapy may occur pending results of clinically indicated studies to exclude these conditions. If a patient is found to have any of these conditions they should be removed from the study once results are received. Patients who are removed due to ineligibility after results are received will be replaced
• Patients with treatment related AML who have received more than 250 mg/m^2 of anthracyclines (in daunorubicin equivalents) are not eligible
• Patients with a known allergy or intolerance to atovaquone are not eligible
• Female patients who are pregnant are ineligible since fetal toxicities and teratogenic effects have been noted for several of the study drugs
• Lactating females are not eligible unless they have agreed not to breastfeed their infants
• Female patients of childbearing potential are not eligible unless a negative pregnancy test result has been obtained