3-AP and Fludarabine in Treating Patients With Myeloproliferative Disorders, Chronic Myelomonocytic Leukemia, or Accelerated Phase or Blastic Phase Chronic Myelogenous Leukemia

Inclusion Criteria

• •Criteria:
• •Not pregnant or nursing
• •Histopathologically confirmed diagnosis of 1 of the following:
• •* Myeloproliferative disorders (MPDs) in aggressive phase or transformation
• •* CML in accelerated phase or blast crisis
• •* Chronic myelomonocytic leukemia in aggressive phase (5-19% bone marrow blasts) or transformation (\> 20% bone marrow blasts)
• •Myeloproliferative disorders (MPDs) in aggressive phase or transformation, including the following:
• •* Polycythemia vera (PV)
• •* Essential thrombocythemia (ET)
• •* Myelofibrosis with myeloid metaplasia
• •* Hypereosinophilic syndrome
• •* Atypical (Philadelphia chromosome negative) chronic myelogenous leukemia (Ph- CML)
• •Patients with aggressive phase MPD (PV, ET, or Ph- CML) must meet ≥ 1 of the following criteria:
• •* Marrow blasts \> 5%
• •* Peripheral blood blasts plus progranulocytes \> 10%
• •* New onset or increasing myelofibrosis
• •* New onset or \> 25% increase in hepatomegaly or splenomegaly
• •* New onset constitutional symptoms (fever, weight loss, splenic pain, bone pain)
• •Multilineage bone marrow failure
• •Ineligible for established curative regimens, including stem cell transplantation
• •ECOG performance status 0-2
• •Negative pregnancy test
• •Fertile patients must use effective contraception
• •No chronic toxicity from prior chemotherapy \> grade 1
• •No history of severe coronary artery disease
• •Creatinine normal OR creatinine clearance \>= 60 mL/min
• •AST and ALT =\< 2.5 times normal
• •Bilirubin =\< 2.0 mg/dL unless due to leukemia, Gilbert's syndrome, or hemolysis
• •No arrhythmias (other than atrial flutter or fibrillation) requiring medication
• •No uncontrolled congestive heart failure
• •No dyspnea at rest or with minimal exertion
• •No severe pulmonary disease requiring supplemental oxygen
• •No history of allergic reactions attributed to compounds of similar chemical or biological composition to 3-AP (Triapine®) and/or fludarabine phosphate
• •No other life-threatening illness
• •No history of mental deficits and/or psychiatric illness that would preclude study compliance
• •No more than 4 prior induction regimens (3 cytotoxic chemotherapy regimens)
• •At least 3 weeks since prior myelosuppressive cytotoxic agents (6 weeks for mitomycin C or nitrosoureas) and recovered
• •At least 1 week since prior nonmyelosuppressive treatment
• •At least 48 hours since prior noncytotoxic agents for peripheral blood leukemic cell count control, including but not limited to the following:
• •* Hydroxyurea
• •* Imatinib mesylate
• •* Interferon
• •* Mercaptopurine
• •* Cyclophosphamide
• •At least 2 weeks since prior and no concurrent radiotherapy to treat cancer
• •At least 1 week since prior biologic therapy, including hematopoietic growth factors (e.g., epoetin alfa, darbepoetin alfa, filgrastim \[G-CSF\], sargramostim \[GM-CSF\], interleukin-3, or interleukin-11)
• •No other concurrent chemotherapy to treat cancer
• •No concurrent immunotherapy to treat cancer
• •No known glucose-6-phosphate dehydrogenase \[G6PD) deficiency (G6PD screening required for high-risk groups (i.e., patients of African, Asian, or Mediterranean origin/ancestry)\]
• •No active heart disease
• •No concurrent myeloid growth factors
• •No active uncontrolled infection (Infections under active treatment and controlled with antibiotics are allowed)
• •No chronic hepatitis