Study of Four Different Chemotherapy Regimens With or Without Total-Body Irradiation Followed by Umbilical Cord Blood Transplant in Treating Patients With Relapsed or Refractory Hematologic Cancer

DISEASE CHARACTERISTICS:

• Histologically confirmed hematological or lymphatic malignancy, including any of the following:

  • Acute myeloid leukemia

    • Relapsed or primary refractory disease with < 10% blasts on peripheral blood smear
    • In first remission with poor risk factors and molecular prognosis [i.e., AML with -5, -7, t(6;9), tri8, -11] (preparative regimen 3 or 4)

  • Acute lymphocytic leukemia

    • In second complete remission or higher OR in first remission with poor risk factors, including any of the following (preparative regimen 1 or 2):

      • BCR/ABL by fluorescence in situ hybridization (FISH) or reverse transcriptase-polymerase chain reaction
      • t(9;22)(q34;q11) detected by cytogenetics
      • Chromosomes < 44 by cytogenetics
      • DNA index < 0.81 by flow cytometry
      • Any rearrangement of chromosome 11 that results in disruption of MLL gene (11q23) by cytogenetics and SER
    • In first remission with poor risk factors and molecular prognosis [ALL with Philadelphia chromosome-positive t(9;22), t(4;22), (q34;q11)] (preparative regimen 3 or 4)

  • Chronic myelogenous leukemia

    • In accelerated phase or greater (preparative regimen 1 or 2)
    • In accelerated or second chronic phase (preparative regimen 3 or 4)

  • Myelodysplastic syndromes

    • With deletion of chromosome 7 or short arm of chromosome 5 (preparative regimen 1 or 2)
    • In high and high-intermediate risk categories (preparative regimen 3 or 4)
  • Non-Hodgkin lymphoma in relapse with marrow involvement
  • Refractory chronic lymphocytic leukemia

• Patients deemed ineligible for conventional high-dose chemotherapy programs (i.e., regimens 1 or 2) due to any of the following concurrent medical conditions may be eligible for regimens 3 or 4 at the discretion of the treating physician and principal investigator (preparative regimen 3 or 4):

  • LVEF < 50% and > 40%
  • FEV1, FVC, or DLCO < 50%
  • Bilirubin > 3 mg/dL
  • Creatinine > 2 mg/dL

• Two partially HLA-matched umbilical cord blood (UCB) units available

  • HLA-matched minimally at 4 of 6 HLA-A, HLA-B, and -DRB1 loci with the patient

    • DRB1 matched by high resolution DNA typing
    • HLA-A and HLA-B matched by low resolution at the "serological match" level
  • Two pooled units with a nucleated cell number > 2.5 x 10^7/kg
• No available HLA-identical sibling or 1 antigen-mismatched related donor
• No available HLA-matched unrelated bone marrow donor

PATIENT CHARACTERISTICS:

• See Disease Characteristics
• Karnofsky performance status (PS) 60-100% OR Lansky PS 60-100% OR Zubrod PS 0-1
• Physiological age 60 or less (at any chronological age)
• Weight > 50 kg
• Creatinine normal for age OR creatinine clearance by 24-hour urine collection or glomerular filtration rate > 60 mL/min
• Bilirubin ≤ 1.5 mg/dL
• LVEF ≥ 50%
• DLCO ≥ 60% of predicted
• No HIV-1 infection
• No active uncontrolled infection
• Not pregnant
• Negative pregnancy test
• Fertile patients must use effective contraception

PRIOR CONCURRENT THERAPY:

• Recovered from prior intensive chemotherapy