OBJECTIVES:

• Determine the effect of irradiated donor T-cell infusion on donor T-cell chimerism 6 weeks after hematopoietic stem cell transplantation in patients with hematologic malignancies.
• Determine the infusional toxic effects of irradiated donor lymphocytes in these patients.
• Determine the risk of acute and chronic graft-versus-host disease from donor lymphocyte infusions on day 45 and day 100 posttransplantation in HLA 6/6 matched transplantations from a related donor in these patients.
• Determine disease-free survival, cytomegalovirus reactivation, and relapse in patients treated with this regimen.
• Determine transplant-related mortality and death from all causes in patients treated with this regimen.

OUTLINE:

• Preparative regimen: Patients receive fludarabine IV over 30 minutes on days -8 to -4 and cyclophosphamide IV over 1 hour on days -3 and -2. Patients undergo total body irradiation on days -7 to -4.
• Pretransplantation irradiated donor lymphocyte infusion (DLI): Patients receive irradiated DLI on day -4.
• Hematopoietic stem cell transplantation (HSCT): Patients undergo allogeneic HSCT on day 0.
• Graft-versus-host disease prophylaxis: Patients receive oral cyclosporine on days 44-120.
• Posttransplantation DLI: Patients receive DLI on days 45 and 100. Patients with chronic myelogenous leukemia in chronic phase who are polymerase chain reaction negative for bcr/abl receive DLI on day 45 only.

Patients are followed at 3, 6, and 12 months and then annually thereafter.

PROJECTED ACCRUAL: A total of 20 patients will be accrued for this study.

DISEASE CHARACTERISTICS:

• Diagnosis of any of the following hematologic malignancies:

  • Chronic myelogenous leukemia (CML) in chronic phase meeting 1 of the following criteria:

    • Under 41 years of age with no prior imatinib mesylate therapy
    • 10 to 55 years of age and failed prior imatinib mesylate therapy
    • 41 to 55 years of age for whom imatinib mesylate is not the treatment of choice
  • CML in accelerated phase or blast transformation

  • Acute lymphoblastic leukemia meeting any of the following criteria:

    • Over 18 years of age and in first remission with high-risk features (e.g., WBC greater than 100,000/mm^3, karyotypes t[9;22], t[4], t[19], t[11], and biphenotypic leukemia)
    • Second or subsequent remission
    • Primary induction failure
    • Partially responding or untreated relapse

  • Acute myeloid leukemia meeting any of the following criteria:

    • First remission, except with good-risk karyotypes (e.g., M3 t[15;17], M4E0 inv[16], t[8;21])
    • Second or subsequent remission
    • Primary induction failure
    • Resistant relapse

  • Myelodysplastic syndromes of any of the following types:

    • Refractory anemia (RA) with transfusion dependence
    • RA with excess blasts
    • In transformation to acute leukemia
    • Chronic myelomonocytic leukemia

  • Myeloproliferative disorders in transformation to acute leukemia, of any of the following types:

    • Myelofibrosis
    • Polycythemia vera
    • Essential thrombocythemia

  • Chronic lymphocytic leukemia that is refractory to fludarabine with 1 of the following:

    • Bulky progressive disease
    • Thrombocytopenia (WBC no greater than 100,000/mm^3)*
    • Anemia (hemoglobin no greater than 10 g/dL)* NOTE: *Not due to recent chemotherapy
  • Non-Hodgkin's lymphoma, including mantle cell lymphoma, relapsing or refractory to current chemotherapy and monoclonal antibody therapy and unsuitable for autologous stem cell transplantation
• Availability of a HLA-identical (6/6) family donor

PATIENT CHARACTERISTICS:

Age

• 10 to 55

Performance status

• ECOG 0-1

Life expectancy

• Not specified

Hematopoietic

• See Disease Characteristics

Hepatic

• Bilirubin no greater than 4 mg/dL
• Transaminases no greater than 3 times upper limit of normal

Renal

• Creatinine no greater than 3 mg/dL

Cardiovascular

• LVEF at least 40% of predicted

Pulmonary

• DLCO at least 60% of predicted

Other

• Not pregnant
• Negative pregnancy test
• HIV negative
• No severe psychiatric illness or mental deficiency that would preclude giving informed consent or complying with study treatment
• No major illness or organ dysfunction that would preclude transplantation
• No other prior malignancy except basal cell or squamous cell skin cancer

PRIOR CONCURRENT THERAPY:

Biologic therapy

• See Disease Characteristics

Chemotherapy

• See Disease Characteristics
• No prior continuous busulfan for more than 6 months duration

Endocrine therapy

• Not specified

Radiotherapy

• Not specified

Surgery

• Not specified