Phase II Study of Azacitidine and Sargramostim as Maintenance Treatment for Poor-Risk AML or MDS

Inclusion Criteria: 1. Age \> 6 months 2. Initial diagnosis of poor -risk AML or MDS (defined in section 3.2), treated with either stem cell transplant or cytarabine-based consolidation chemotherapy, within the past 60-185 days 3. ECOG performance status 0-2 4. No morphologic evidence of leukemia or active MDS as determined by JHH Hematopathologist independent review of a bone marrow aspirate and biopsy done following the completion of therapy and within 14 days prior to enrollment 5. Peripheral blood count recovery: Neutrophil count ≥ 1000 /µL, platelet count ≥ 50x 109 /µL without platelet transfusions, and adequate hematocrit independent of red cell transfusions . 6. No evidence of extramedullary leukemia, such as CNS or soft tissue involvement 7. Adequate end organ function as measured by the following: AST and ALT \< 4 x normal, total serum bilirubin \< 2 x upper limit normal (unless due to hemolysis, Gilbert's syndrome, or ineffective erythropoiesis), creatinine \< 2 x upper limit of normal 8. Ability to give informed consent 9. In agreement to use an effective barrier method of birth control to avoid pregnancy during the study and for a minimum of 30 days after study treatment, for all male and female patients who are fertile Exclusion Criteria: 1. Patients with untreated or uncontrolled infections 2. Patients with untreated or uncontrolled grade 3 or 4 GVHD 3. Pregnancy and lactation 4. Concurrent use of any other investigational agents. 5. Known HIV-positive patients. 6. Known hypersensitivity to 5AC or GM-CSF