Grade 3 treatment-emergent adverse events in the amrubicin and topotecan arms were : neutropenia ( 41 % v 54 % ; P = .004 ) , thrombocytopenia ( 21 % v 54 % ; P < .001 ) , anemia ( 16 % v 31 % ; P < .001 ) , infections ( 16 % v 10 % ; P = .043 ) , febrile neutropenia ( 10 % v 3 % ; P = .003 ) , and cardiac disorders ( 5 % v 5 % ; P = .759 ) ; transfusion rates were 32 % and 53 % ( P < .001 ) , respectively .