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