Bone Marrow Transplantation in Treating Patients With Hematologic Cancer

DISEASE CHARACTERISTICS:

• Histologically proven hematologic malignancy of 1 of the following types:

  • Chronic myelogenous leukemia (CML) in chronic, accelerated, or blast* phase

  • Acute leukemia with high-risk features at diagnosis such as:

    • Philadelphia chromosome-positive acute lymphocytic leukemia**
    • Acute myeloid leukemia with high-risk cytogenetics such as inv (3), t(3;3) del(5q), -5, del(7q), -7, +8, +11, abnormal 12p, del(20q), -20, or complex abnormalities**
  • Acute leukemia with failure after one course of induction chemotherapy
  • Acute leukemia in first relapse* or second remission
  • High-risk lymphoblastic lymphoma in first remission
  • Non-Hodgkin's lymphoma, Hodgkin's disease, or other malignant lymphoproliferative disease after first remission, if an autologous transplantation is not indicated
  • Myelodysplastic or myeloproliferative syndromes ineligible for Protocol FHCRC-179 NOTE: * For patients with acute leukemia in relapse or CML in blast crisis, the search for an unrelated donor begins only if: High probability that the patient's medical condition will remain stable for the 3 to 6-month period needed to find a donorAn attempt at remission induction has been undertaken Referring physician and patient accept possibility that search for donor will be canceled if patient's condition worsens

NOTE: ** For newly diagnosed patients with high-risk acute leukemia, early referral is encouraged so that an unrelated donor search may begin immediately

• Availability of an unrelated donor with:

  • 1 HLA-A or B non-cross-reactive group (non-CREG) mismatch (except in CML in chronic phase or myelodysplastic syndrome) OR
  • 1 HLA-A or B CREG mismatch OR

  • An HLA-A, B, and C match with an HLA-DRB1 or DQB1 mismatch (no double mismatch) if 1 of the above 2 donor types unavailable

    • No more than 1 HLA-A, B, and C mismatch

• No availability of an HLA-identical sibling or haploidentical relative incompatible for 0 or 1 HLA-A or B locus of the nonshared haplotypes

  • For patients with diagnosis other than CML in chronic phase, 1 HLA-DR locus-incompatible related donor has priority over an HLA compatible or class IA or B CREG locus antigen-incompatible unrelated donor
• No severe aplastic anemia
• No leukoencephalopathy

PATIENT CHARACTERISTICS:

Age:

• Under 51
• Eligible for transplantation until age 52 if the donor is identified prior to patient's 51st birthday

Performance status:

• Not specified

Life expectancy:

• Not specified

Hematopoietic:

• See Disease Characteristics

Hepatic:

• No severe hepatic disease, including acute hepatitis

Renal:

• Creatinine less than 2 times normal

Cardiovascular:

• No cardiac insufficiency requiring treatment
• No symptomatic coronary artery disease

Pulmonary:

• No severe hypoxemia (i.e., PO2 less than 70 mm Hg) with decreased DLCO (i.e., DLCO less than 70% predicted) OR
• No mild hypoxemia (i.e., PO2 less than 80 mm Hg) with severely decreased DLCO (i.e., DLCO less than 60% predicted)
• No pulmonary fibrosis

Other:

• No other nonmalignant disease that would severely limit life expectancy
• HIV negative
• No contraindication to total body irradiation (TBI)
• Patients excluded from this study because of contraindication to TBI may be treated on protocol FHCRC-739

PRIOR CONCURRENT THERAPY:

Biologic therapy:

• See Disease Characteristics

Chemotherapy:

• See Disease Characteristics

Endocrine therapy:

• Not specified

Radiotherapy:

• No prior radiotherapy greater than 3,000 cGy to whole brain
• At least 6 months since prior involved-field radiotherapy greater than 1,500 cGy to chest or abdomen

Surgery:

• Not specified