Inclusion Criteria:

          1. Patients with confirmed diagnosis of acute myeloid leukemia (WHO 2016) and
             intermediate or adverse genetic risk (according to 2017 ELN recommendations); or
             patients with myelodysplastic syndrome with excess blasts-2 (MDS-EB-2)

          2. Patients ≥60 years of age

          3. No prior chemotherapy for leukemia except hydroxyurea to control hyperleukocytosis for
             up to 10 days during the diagnostic screening phase; patients may have received prior
             therapy for myelodysplastic syndrome different from hypomethylating agents

          4. ECOG performance status ≤2

          5. Men must use a latex condom during any sexual contact with women of childbearing
             potential, even if they have undergone a successful vasectomy and must agree to avoid
             to father a child (while on therapy and for 3 month after the last dose of vosaroxin)

          6. Non-pregnant and non-nursing women of childbearing potential (WOCBP) must have a
             negative serum or urine pregnancy test within a sensitivity of at least 25 mIU/mL
             within 72 hours prior to registration ("Women of childbearing potential" is defined as
             a sexually active mature woman who has not undergone a hysterectomy or who has had
             menses at any time in the preceding 24 consecutive months).

          7. Female patients of reproductive age must agree to avoid getting pregnant while on
             therapy and for 3 months after the last dose of vosaroxin.

          8. Women of child-bearing potential including the female partners of the male patients
             must either commit to continued abstinence from heterosexual intercourse or apply two
             acceptable methods of birth control (IUD, tubal ligation, or partner's vasectomy).
             Hormonal contraception is an inadequate method of birth control.

          9. Men must use a latex condom during any sexual contact with women of childbearing
             potential, even if they have undergone a successful vasectomy (while on therapy and
             for three months after the last dose of chemotherapy)

         10. Willing to adhere to protocol specific requirements

         11. Following receipt of verbal and written information about the study, the patient must
             provide signed informed consent before any study related activity is carried out

        Exclusion Criteria:

          1. Known or suspected hypersensitivity to the study drugs and/or any excipients

          2. Favorable genetics: t(15;17)(q22;q12), PML-RARA; t(8;21)(q22;q22), RUNX1-RUNX1T1;
             inv(16)(p13.1q22)/t(16;16)(p13.1;q22), CBFB-MYH11; mutated NPM1 without FLT3-ITD or
             with FLT3-ITDlow

          3. Prior treatment for AML except hydroxyurea

          4. Prior treatment for MDS with hypomethylating agents

          5. ECOG performance status >2

          6. Patients who are not eligible for intensive chemotherapy

          7. Inadequate cardiac, hepatic and/or renal function at the Screening Visit defined as:

               -  Ejection fraction <40% confirmed by echocardiography

               -  Creatinine >1.5x upper normal serum level

               -  Total bilirubin, AST or ALT >1.5 upper normal serum level

          8. Active central nervous system involvement

          9. Any clinically significant, advanced or unstable disease or history of that may
             interfere with primary or secondary variable evaluations or put the patient at special
             risk, such as:

               -  Myocardial infarction, unstable angina within 3 months before screening

               -  Heart failure NYHA III/IV

               -  Severe obstructive or restrictive ventilation disorder

               -  Uncontrolled infection

         10. Severe neurological or psychiatric disorder interfering with ability of giving an
             informed consent

         11. Currently receiving a therapy not permitted during the study, as defined in Section
             10.5.4

         12. Patients with a "currently active" second malignancy other than non-melanoma skin
             cancers. Patients are not considered to have a "currently active" malignancy if they
             have completed therapy and are considered by their physician to be at less than 30%
             risk of relapse within one year.

         13. Known history of positive test for Hepatitis B surface Antigen (HBsAg) or hepatitis C
             antibody or history of positive test for Human Immunodeficiency Virus (HIV)

         14. Hematological disorder independent of leukemia

         15. No consent for registration, storage and processing of the individual disease
             characteristics and course as well as information of the family physician and/or other
             physicians involved in the treatment of the patient about study participation

         16. No consent for biobanking

         17. Current participation in any other interventional clinical study within 30 days before
             the first administration of the investigational product or at any time during the
             study

         18. Patients known or suspected of not being able to comply with this trial protocol

         19. Patients of childbearing potential not willing to use adequate contraception during
             study and 3 months after last dose of therapy

         20. Breast feeding women or women with a positive pregnancy test at Screening visit