AlloHCT From Matched Unrelated Donors in Pts w/ Advanced Hematologic Malignancies & Disorders

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• 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