Fludarabine and PK-Directed Busulfan With or Without ATG Followed By Donor Peripheral Stem Cell Transplant in Treating Patients With Hematologic Cancer or Other Diseases (LCCC 0510)

DISEASE CHARACTERISTICS:

• Histologically confirmed diagnosis of any of the following:

  • Chronic lymphocytic leukemia or prolymphocytic leukemia

    • Chemotherapy-refractory or advanced disease after ≥ 3 prior treatments

  • Chronic myelogenous leukemia

    • Diagnosis based on t(9;22) or related t(9;12) cytogenetic abnormalities AND characterized by elevated WBC counts in peripheral blood or marrow
    • Patients with progressive disease on imatinib mesylate or other protein tyrosine kinase inhibitors; less than a major cytogenetic or fluorescent in situ hybridization (FISH) complete response (CR) after a minimum of 6 months of targeted therapy; or less than a complete FISH or cytogenetic response after 12 months of targeted therapy are eligible
    • Patients with other cytogenetic abnormalities, such as t(9;12), that are associated with an aggressive clinical course are eligible

  • Non-Hodgkin's lymphoma (NHL) or Hodgkin's lymphoma

    • Any WHO classification histologic subtype allowed
    • Must have advanced disease as defined by relapse after initial CR or failure to achieve CR OR deemed to have less than a 30% likelihood of durable response with an autologous stem cell transplant
    • Refractory low-grade NHL histologies or any intermediate or aggressive large cell or mantle cell lymphoma allowed

  • Acute myeloid leukemia (AML)

    • High-risk disease in first CR (CR1) OR evidence of any recurrent disease beyond CR1

      • High-risk individuals are those requiring more than 1 course of induction therapy to achieve remission; those with extra-medullary disease at presentation; or those with high-risk cytogenetic abnormalities (abnormalities of chromosomes 5, 7, 2, trisomy 8, or 3) or > 2 cytogenetic abnormalities
  • Multiple myeloma

  • Myelodysplastic syndromes (MDS)

    • Must have MDS defined by WHO criteria with > 5% blasts or high-risk cytogenetic abnormalities (abnormalities of chromosomes 5, 7, 2, trisomy 8, or 3)

  • Acute lymphoblastic leukemia (ALL)

    • High-risk disease in CR1 OR beyond CR1

      • High-risk disease includes the following: t(9;22) or t(4;11); WBC > 30,000/mm³ at presentation; non-T-cell phenotype; or more than 30 years of age

  • Myelofibrosis/agnogenic myeloid metaplasia

    • Patients must be transfusion dependant or have evidence of evolving AML as evidenced by an excess of blasts or a state of marrow failure/fibrosis
    • Myeloproliferative disorders with advanced disease (e.g., progressive or spent phase polycythemia vera, myelofibrosis, or essential thrombocythemia)

• Any of the following categories of donors are acceptable*:

  • HLA-identical or 1 antigen-mismatched sibling (5/6, 6/6, or 8/10) donor

    • Minimal serologic typing required for class I (A, B); molecular typing required for class II (DRB1)

  • 8/10 matched unrelated donor (MUD)

    • Molecular analysis at HLA-A, -B, -C, -DRB1 and -DQB1 (8/10 match) by high resolution typing is required

  • 5/6 MUD

    • Molecular analysis at HLA-A, -B, and -DRB1 required NOTE: *No syngeneic donors

PATIENT CHARACTERISTICS:

• Performance status 0-2
• Bilirubin ≤ 2 times upper limit of normal (ULN)
• AST ≤ 2 times ULN
• Creatinine clearance ≥ 50 mL/min
• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception
• DLCO > 60% with no symptomatic pulmonary disease
• LVEF ≥ 50% by MUGA
• No uncontrolled or severe cardiovascular disease, pulmonary disease, or infection that, in the opinion of the treating physician, would make this study unreasonably hazardous to the patient
• No other serious illness that would limit survival to < 2 years
• No psychiatric condition that would preclude study compliance
• No uncontrolled diabetes mellitus or active serious infection
• No active second malignancy except for nonmelanomatous skin cancer
• No known hypersensitivity to E. coli-derived products
• No HIV positivity

PRIOR CONCURRENT THERAPY:

• See Disease Characteristics

• More than 4 weeks since prior chemotherapy, radiotherapy, or surgery

  • Cranial radiotherapy or intrathecal therapy as prophylaxis against CNS recurrence within the past 4 weeks allowed (in high-risk patients)