• Disease-free survival (DFS) 1-2 years after completion of study treatment [ Designated as safety issue: No ]
• Overall survival (OS) 1-2 years after completion of study treatment [ Designated as safety issue: No ]
• Engraftment of donor cells at days 30 and 100 [ Designated as safety issue: No ]
• Toxicity or acute graft-versus-host disease at days 1-100 [ Designated as safety issue: Yes ]
• Chronic graft-versus-host disease at 6 months, and then 1 and 2 years [ Designated as safety issue: No ]

• Disease-free survival (DFS) 1-2 years after completion of study treatment
• Overall survival (OS) 1-2 years after completion of study treatment
• Engraftment of donor cells at days 30 and 100
• Toxicity or acute graft-versus-host disease at days 1-100
• Chronic graft-versus-host disease at 6 months, and then 1 and 2 years

RATIONALE: Photopheresis treats the patient's blood with drugs and ultraviolet light outside the body and kills the white blood cells. Giving photopheresis, pentostatin, and radiation therapy before a donor bone marrow or stem cell transplant helps stop the patient's immune system from rejecting the donor's stem cells. The donated stem cells may replace the patient's immune system and help destroy any remaining cancer cells (graft-versus-tumor effect). Sometimes the transplanted cells from a donor can also make an immune response against the body's normal cells. Giving pentostatin before transplant and cyclosporine or mycophenolate mofetil after transplant may stop this from happening.

PURPOSE: This phase II trial is studying how well giving pentostatin together with photopheresis and total-body irradiation work before donor bone marrow transplant in treating patients with myelodysplastic syndromes.

OBJECTIVES:

• Determine the complete response rate in patients with myelodysplastic syndromes treated with reduced-intensity allogeneic bone marrow transplantation, including photopheresis, total body irradiation, and pentostatin.
• Determine the disease-free and overall survival of patients treated with this regimen.
• Determine the engraftment rate of donor cells in patients treated with this regimen.
• Determine the toxicity of this regimen in these patients.
• Determine the extent and duration of acute and chronic graft-versus-host disease in patients treated with this regimen.

OUTLINE: This is a multicenter study.

• Preparative Regimen: Patients undergo photopheresis using methoxsalen on days -7 and -6 and receive pentostatin IV continuously on days -5 and -4. Total body irradiation is administered on days -3 and -2 for a total of 3 doses.
• Transplantation: Allogeneic bone marrow or peripheral blood stem cells are infused on day 0.
• Acute graft-vs-host-disease (GVHD) prophylaxis: Patients receive cyclosporine IV on days -1 to 30 and then orally every 12 hours. Cyclosporine dose is then tapered beginning after day 50 and continuing for 6 months in the absence of GVHD. Once cyclosporine dose is significantly decreased, oral mycophenolate mofetil (MMF) is then administered twice a day. MMF dose is then tapered for 12 months in the absence of GVHD. Patients also receive methotrexate IV on days 1 and 3.

Patients are followed every 3 months for 2 years, every 6 months for 3 years, and then annually thereafter.

PROJECTED ACCRUAL: A total of 33 patients will be accrued for this study within 2.1 years.

• Leukemia
• Myelodysplastic Syndromes
• Myelodysplastic/Myeloproliferative Diseases

• Drug: cyclosporine
• Drug: methotrexate
• Drug: methoxsalen
• Drug: mycophenolate mofetil
• Drug: pentostatin
• Procedure: allogeneic bone marrow transplantation
• Procedure: peripheral blood stem cell transplantation
• Radiation: radiation therapy

DISEASE CHARACTERISTICS:

• One of the following cytologically proven myelodysplastic syndromes

  • Refractory anemia (RA)
  • RA with ringed sideroblasts
  • RA with excess blasts
  • Chronic myelomonocytic leukemia

• International Prognosis Scoring System (IPSS) score of at least 0.5 OR red cell transfusion dependence for at least 6 months (2 units per month)

  • Patients with an IPSS score less than 0.5 may be eligible provided they previously had a higher IPSS score and received chemotherapy at that time

• Suitable HLA-matched donor (related or unrelated) available

  • No cord blood donors
  • Related donors must be genotypically matched (HLA A, B and DR) at 5/6 or 6/6 loci and may be a sibling, parent, or child
  • Unrelated donors must have high resolution typing done at A, B, C and DR, and must be matched at all or may have a single antigen or allele mismatch at no more than one of these loci
• Patients must have < 20% blasts on bone marrow study within 1 month of study entry

PATIENT CHARACTERISTICS:

Age

• 18 to 70

Performance status

• ECOG 0-1

Life expectancy

• At least 6 months

Hematopoietic

• See Disease Characteristics
• Serum erythropoietin level greater than 100 for patients who have not received a prior course of epoetin alfa

• No iron deficiency

  • Iron deficiency anemia treated with iron replacement therapy allowed

Hepatic

• Bilirubin less than 2.0 mg/dL
• Alkaline phosphatase less than 2 times upper limit of normal (ULN)
• AST and ALT less than 3 times ULN

Renal

• Creatinine less than 2.0 mg/dL OR
• Creatinine clearance greater than 50 mL/min

Cardiovascular

• LVEF at least 45% by MUGA or echocardiogram

Pulmonary

• DLCO at least 50% of predicted (corrected for hemoglobin)
• FEV_1 at least 50% of predicted

Other

• Physically and psychologically capable of undergoing study regimen
• Able to receive 600 cGy of total body irradiation
• HIV negative
• Not pregnant or nursing
• Negative pregnancy test
• No other medical condition that would reduce life expectancy
• No active ongoing infection

PRIOR CONCURRENT THERAPY:

Biologic therapy

• See Disease Characteristics
• See Hematopoietic
• At least 90 days since prior autologous bone marrow transplantation
• No prior myeloablative or nonmyeloablative allogeneic transplantation for myelodysplastic syndrome or acute myeloid leukemia

Chemotherapy

• Recovered from prior chemotherapy

Endocrine therapy

• Not specified

Radiotherapy

• Not specified

Surgery

• Not specified