Rituximab, Alemtuzumab, and GM-CSF As First-Line Therapy in Treating Patients With Early-Stage Chronic Lymphocytic Leukemia

DISEASE CHARACTERISTICS:

• Diagnosis of chronic lymphocytic leukemia (CLL) meeting the following criteria:
• Minimum threshold peripheral blood lymphocyte count 5 x 10^9/L
• Monoclonality (light chain exclusion) of B lymphocytes detected by immunophenotyping (CD19-positive), demonstrating ≥ 3 of the following characteristics:
• CD5-positive
• CD23-positive
• Dim surface light chain expression
• Dim surface CD20 expression
• Negative for IGH/CCND1 translocation AND/OR immunostaining is negative for cyclin D1 expression by fluorescent in-situ hybridization (FISH) analysis
• Rai stage 0, I, or II disease that does not meet standard NCI-Working Group criteria for treatment of CLL
• Poor prognosis as defined by ≥ 1 of the following factors:
• Unmutated IgVH mutation status AND CD38 expression (i.e., ≥ 30% cells positive on flow cytometry)
• Unmutated IgVH mutation status AND ZAP-70 expression (i.e., ≥ 20% cells positive on flow cytometry)
• VH3-21 gene segment use irrespective of mutation status AND CD38 expression (≥ 30% cells positive on flow cytometry)
• VH3-21 gene segment use irrespective of mutation status AND ZAP-70 expression (≥ 20% cells positive on flow cytometry)
• 11q-negative*
• 17p-negative* NOTE: *Determination of IgVH mutation status is not required in patients whose eligibility is based on 17p13- or 11q22- deletions

PATIENT CHARACTERISTICS:

• ECOG performance status 0- 2
• Creatinine ≤ 1.5 times upper limit of normal (ULN)
• Total bilirubin ≤ 3.0 times ULN OR direct bilirubin ≤ 1.5 ULN
• AST ≤ 3.0 times ULN (unless due to hemolysis or CLL)
• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must practice effective contraception
• Willing to provide mandatory blood samples (for patients at the Mayo Clinic in Rochester only) for research studies as required by the protocol
• No comorbid conditions, including any of the following:
• New York Heart Association Class III or IV heart disease
• Myocardial infarction within the past month
• Uncontrolled infection
• HIV infection or AIDS
• Serological evidence of active hepatitis B infection (i.e., serum antigen or e-antigen positivity) or positive hepatitis C serology
• No other active primary malignancy requiring treatment or limiting survival to ≤ 2 years
• No active autoimmune hemolytic anemia, immune thrombocytopenia, or pure red blood cell aplasia

PRIOR CONCURRENT THERAPY:

• More than 4 weeks since prior major surgery
• No prior chemotherapy or monoclonal antibody treatment for CLL
• No concurrent corticosteroids