Bexarotene and GM-CSF in Treating Patients With Myelodysplastic Syndrome or Acute Myeloid Leukemia

DISEASE CHARACTERISTICS:

• Diagnosis (confirmed by bone marrow aspirate and/or biopsy) of 1 of the following:

  • Myelodysplastic syndromes of 1 of the following cell types:

    • Refractory anemia (RA) with ringed sideroblasts
    • Refractory cytopenia with multilineage dysplasia (RCMD)
    • RCMD and ringed sideroblasts
    • RA with excess blasts-1
    • RA with excess blasts-2
    • Myelodysplastic syndromes, unclassified
    • Chronic myelomonocytic leukemia

  • Relapsed or refractory acute myeloid leukemia (AML), meeting 1 of the following criteria:

    • Recurrent genetic abnormalities (11q23 [MLL] abnormalities)
    • Multilineage dysplasia
    • Therapy-related AML

    • Not otherwise categorized, including any of the following:

      • M0 minimally differentiated
      • M1 without maturation
      • M2 with maturation
      • M4 myelomonocytic leukemia
      • M5 monoblastic/monocytic leukemia
      • M6 erythroid leukemia
      • M7 megakaryoblastic leukemia
• Newly diagnosed untreated AML allowed provided patient does not qualify for or refused potentially curative intensive chemotherapeutic regimens
• No RA with 5q-syndrome
• No peripheral leukemia with blast count > 30,000/mm³ (uncontrolled with hydroxyurea)
• Relatively stable bone marrow function for > 7 days (i.e., no WBC doubling to > 10,000/mm^3)
• No acute promyelocytic leukemia
• No clinical symptoms of active CNS disease (if CNS disease is suspected, patient must have lumbar puncture with negative cytology)

PATIENT CHARACTERISTICS:

• ECOG performance status 0-2
• Creatinine ≤ 2.0 mg/dL
• Bilirubin ≤ 1.6 mg/dL (unless secondary to hemolysis)
• AST and ALT ≤ 4 times upper limit of normal (unless disease related)
• Hemoglobin ≥ 8 g/dL (transfusions allowed)
• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective barrier contraception
• No untreated positive blood cultures or progressive infection as assessed by radiographic studies
• No history of intolerance to sargramostim (GM-CSF)

PRIOR CONCURRENT THERAPY:

• Recovered from prior therapy

• At least 2 weeks since prior treatment for myeloid disorder, including any of the following:

  • Chemotherapy
  • Hematopoietic growth factors
  • Biologic therapy (e.g., monoclonal antibodies)
• Hydroxyurea for patients with WBC > 10,000/mm^3 allowed
• No concurrent vitamin A supplementation
• No concurrent gemfibrozil