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

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