VNP40101M Followed by Cytarabine in Treating Older Patients With Acute Myeloid Leukemia

DISEASE CHARACTERISTICS:

* Histologically confirmed de novo acute myeloid leukemia (AML)

  * No acute promyelocytic leukemia \[t(15;17)\]
  * No favorable cytogenetics, including t(15;17), t(8;21), or inv 16
  * No secondary AML, defined as having a history of an antecedent hematologic disorder (myelodysplastic syndromes \[MDS\] or myeloproliferative disease), or history of prior chemotherapy or radiation for a disease other than AML
* Must have ≥ 1 of the following poor-risk features:

  * Any of the following unfavorable cytogenetics:

    * Del (5q)/-5q
    * -7/del(7q)
    * Abnormal 3q, 9q, 11q, 20q, 21q, or 17p
    * t(6;9)
    * t(9;22)
    * Trisomy 8
    * Complex karyotypes (≥ 3 unrelated abnormalities)
  * At least 70 years of age
  * ECOG performance status (PS) of 2
  * Cardiac dysfunction\* that would limit the use of anthracycline therapy, as defined by any of the following:

    * Ejection fraction ≤ 50%
    * History of significant coronary artery disease, defined as ≥ 1 vessel stenosis requiring medical treatment, stent placement, or surgical bypass graft
    * History of congestive heart failure or myocardial infarction
    * Significant arrhythmia, including any of the following:

      * Atrial flutter (excluding atrial fibrillation)
      * Sick sinus syndrome
      * Ventricular arrhythmia
    * Heart valve disease

      * Mitral valve prolapse allowed
    * Other heart disease, at the discretion of the principal investigator
  * Pulmonary dysfunction not related to AML, defined by 1 of the following:

    * DLCO and/or FEV\_1 \< 80% and ≥ 50% normal range
    * Dyspnea on slight activity or at rest
    * Requires oxygen
  * Hepatic dysfunction related to chronic hepatitis or liver cirrhosis
  * Other organ dysfunction or comorbidity that precludes standard cytotoxic induction treatment (e.g., "3+7"), at the discretion of the principal investigator NOTE: \*Patients with a history of heart disease as defined above must be on appropriate medication and have their disease under control
* No known CNS disease

PATIENT CHARACTERISTICS:

* ECOG PS 0-2
* AST and ALT ≤ 5 times upper limit of normal
* Bilirubin ≤ 2.0 mg/dL
* Creatinine ≤ 2.0 mg/dL
* Not pregnant or nursing
* Negative pregnancy test
* Fertile patients must use effective contraception during and for 6 months after completion of study treatment
* No active, uncontrolled infection

  * Patients with an infection who are under active treatment with antibiotics and whose infections are controlled are eligible
  * Chronic hepatitis allowed
* No clinical evidence of ongoing second malignancy unrelated to AML or MDS
* No evidence of left bundle branch block on screening ECG
* No obligate use of cardiac pacemaker or atrial fibrillation

PRIOR CONCURRENT THERAPY:

* See Disease Characteristics
* At least 24 hours since prior metronidazole
* No prior low-dose, single-agent, cytotoxic chemotherapy (e.g., cytarabine, decitabine, or azacitidine)
* No concurrent disulfiram
* No other concurrent standard or investigational therapy for AML except for the following:

  * Concurrent hydroxyurea to control rising white blood cell counts

    * Dosage must be 4-6 grams daily for up to 4 days
  * Concurrent leukapheresis to control blast cell counts

    * Must be completed within the first 5 days of study therapy
    * No more than 2 procedures per day or 4 procedures total
  * Investigational supportive care agents (e.g., antimicrobials or antifungal agents), at the discretion of the protocol sponsor