Azacitidine in Treating Patients With Chronic Myelomonocytic Leukemia

DISEASE CHARACTERISTICS:

* Diagnosis of 1 of the following:

  * All chronic myelomonocytic leukemia (CMML)-2 patients
  * CMML-1 patients meeting any of the following criteria:

    * Symptomatic bone marrow failure/myeloproliferation defined as any of the following:

      * Red cell transfusion dependence and pre-transfusion hemoglobin \< 9.0 g/dL
      * Symptomatic anemia (hemoglobin \< 11.5 g/dL)
      * Thrombocytopenia (platelet count \< 50 x 10\^9/L)
      * Symptomatic bleeding due to platelet functional defect or disseminated intravascular coagulation (DIC)/fibrinolysis
      * White cell count (WCC) \> 50 x 10\^9/L
    * Düsseldorf Score of intermediate or high risk for proliferative CMML-1 (i.e., WCC \> 12 x 10\^9/L)
    * International Prognostic Scoring System (IPSS) score of intermediate-2 or high risk for non-proliferative CMML-1 (i.e., WCC \< 12 x 10\^9/L)
    * Systemic symptoms including weight loss with no alternative explanation (10% of baseline weight within the past 6 months)
    * Symptomatic splenomegaly
    * Symptomatic extramedullary involvement (e.g. skin infiltration or serous effusions)
* No CMML with eosinophilia and 5q33 abnormality

PATIENT CHARACTERISTICS:

* WHO performance status 0-2
* Creatinine ≤ 2 times upper limit of normal
* Not pregnant or nursing
* Negative urine pregnancy test
* Fertile patients must use at least 2 forms of effective contraception during study and for 3 months after completion of study therapy
* No other active malignant disease including basal cell or squamous cell carcinoma of the skin
* No known HIV or infectious hepatitis B or hepatitis C
* No active infection
* No known hypersensitivity to azacitidine or mannitol

PRIOR CONCURRENT THERAPY:

* At least 28 days since other prior experimental drug or therapy
* No prior chemotherapy for this disease except hydroxycarbamide
* No other concurrent anticancer or investigational agents