Decitabine Plus mBU/CY for High Risk Acute Leukemia With MRD Pre-HSCT

This study is testing whether adding a drug called decitabine — a medication that works by reprogramming how genes are read in cancer cells — to a standard pre-transplant chemotherapy regimen (called mBU/CY) can improve outcomes for patients with high-risk leukemia who still have detectable cancer cells (called minimal residual disease or MRD) before their stem cell transplant. MRD-positive patients face higher relapse risk after transplant, so researchers are looking for better conditioning strategies to eliminate more cancer cells before transplantation. **You may be eligible if...** - You have acute leukemia with specific high-risk genetic features (such as MLL-rearrangement, TLS-ERG, or SIL-TAL1 gene abnormalities) - Minimal residual disease — small traces of cancer cells — can still be detected in your body before the transplant **You may NOT be eligible if...** - You are pregnant - You have a severe, uncontrolled infection Talk to your doctor to see if this trial is right for you.