Busulfan and Fludarabine Before Donor Stem Cell Transplant in Treating Patients With Hematologic Cancer

DISEASE CHARACTERISTICS:

• Diagnosis of 1 of the following hematopoietic disorders:

  • Chronic myelogenous leukemia (CML), meeting 1 of the following criteria:

    • Chronic phase disease failing imatinib mesylate therapy

      • Progressive disease OR failed to achieve a major cytogenetic response at 1 year after initiation of therapy

    • Accelerated phase disease, meeting 1 of the following criteria:

      • Failed to achieve complete cytogenetic remission at 1 year after initiation of therapy
      • Failed to achieve any cytogenetic response at 3 or 6 months during therapy
      • Progressive disease, demonstrated by worsening cytogenetic response in 2 consecutive analyses separated by 4 weeks
    • Blast crisis with < 10% blasts in bone marrow within 6 weeks of transplantation

  • Acute myeloid leukemia (AML), meeting 1 of the following criteria:

    • In second or greater remission
    • In first remission with poor prognosis cytogenetics [-5, -5q, -7, -7q and ≥ 2 cytogenetic abnormalities, t(6,9), t(9,11), or Philadelphia chromosome]
    • In hematologic remission but with persistent cytogenetic abnormalities
    • Primary refractory AML with < 10% blasts in bone marrow within 6 weeks of transplantation

  • Myelodysplasia with < 20% blasts in bone marrow within 6 weeks of transplantation and meeting 1 of the following criteria:

    • Advanced disease (International Prognostic Scoring System [IPSS] score intermediate-1, intermediate-2, or high risk)
    • Myelodysplastic syndromes (MDS) with progression to AML
    • Treatment-related AML

  • Acute lymphocytic leukemia (ALL), meeting 1 of the following criteria:

    • In second or greater remission
    • In first remission with high-risk cytogenetics [Philadelphia chromosome; t(4,11); and -7]
    • Primary refractory ALL with < 10% blasts in the bone marrow
  • Severe aplastic anemia that has failed immunosuppressive therapy

  • Non-Hodgkin's lymphoma, meeting 1 of the following criteria:

    • In second or greater remission
    • Relapsed disease in a patient not eligible for autologous stem cell transplantation

  • Lymphoproliferative disease (e.g., chronic lymphocytic leukemia or Waldenstrom's macroglobulinemia), meeting 1 of the following criteria:

    • In second or greater remission
    • Relapsed disease in a patient not eligible for autologous stem cell transplantation

  • Multiple myeloma, meeting 1 of the following criteria:

    • Stage II or III disease in first or greater relapse
    • Refractory disease
    • Newly diagnosed disease with chromosome 13 abnormalities

  • Advanced myeloproliferative disease, meeting 1 of the following criteria:

    • Myelofibrosis requiring > 2 units of packed red blood cells each month
    • Essential thrombocythemia or polycythemia rubra vera that has progressed to AML
    • Failed prior AML therapy
• No active, uncontrolled CNS leukemia
• Not eligible for autologous or mini-allogeneic transplantation
• No fully matched or single-antigen mismatched sibling donor available

• HLA-matched unrelated donor available

  • HLA typed at HLA-A, -B, -C, -DRB1 and/or -DQB1 by high-resolution techniques
  • For patients without HLA identical donors, mismatches at DQ (i.e., 8/8 match) and 1 additional mismatch at the allele level at HLA-A, -B, -C, or -DRB1 (i.e., 7/8 molecular match) allowed

PATIENT CHARACTERISTICS:

• ECOG performance status 0-2
• Creatinine < 2.0 mg/dL
• Pulmonary diffusing capacity > 40% of predicted
• Cardiac ejection fraction > 40% by MUGA or echocardiography
• No active liver disease
• Bilirubin ≤ 2.0 mg/dL
• Alkaline phosphatase < 3 times upper limit of normal (ULN)
• AST < 3 times ULN

• Hepatitis C or active hepatitis B (HBV) allowed provided a liver biopsy is performed and ≤ grade 2 inflammation is present

  • Patients with active HBV viral replication must receive antiviral therapy
• HIV negative
• No ongoing active infection
• Not pregnant or nursing
• Negative pregnancy test

PRIOR CONCURRENT THERAPY:

• See Disease Characteristics
• More than 3 weeks since prior chemotherapy except for hydroxyurea or imatinib mesylate
• More than 3 months since prior interferon