Umbilical Cord Blood Transplantation in Treating Patients With Hematologic Cancer or Nonmalignant Hematologic Disease

Inclusion Criteria

• •DISEASE CHARACTERISTICS:
• •One of the following diagnoses:
• •* Acute myeloid leukemia (AML), with or without myelodysplastic syndromes
• •* Not in first complete remission (CR)\* with translocations t(8;21) and inv (16) unless failure of first-line induction therapy
• •* Not in first CR\* with translocations t(15;17) abnormality unless:
• •* Failure of first-line induction therapy OR
• •* Molecular evidence of persistent disease
• •* Not in first CR with Down syndrome
• •* Patients with third or greater medullary relapse or refractory disease (other than primary induction failures) receive busulfan/melphalan conditioning regimen NOTE: \* CR defined by no greater than 5% blasts in marrow
• •* Acute lymphocytic leukemia (ALL)
• •* Not in first CR OR
• •* High-risk ALL in first CR, with high risk defined as one of the following:
• •* Hypoploidy (no greater than 44 chromosomes)
• •* Pseudodiploidy with translocations or molecular evidence of t(9;22), 11q23, or t(8;14) (except B-cell ALL) with or without MLL gene arrangement
• •* Elevated WBC at presentation
• •* Age 6-12 months: greater than 100,000/mm\^3
• •* Age 10-17 years: greater than 200,000/mm\^3
• •* Age 18: greater than 20,000/mm\^3
• •* Failed to achieve CR after 4 weeks of induction therapy
• •* Patients with B-ALL must not be in first CR, must meet at least one of the high-risk criteria specified above, or must not meet any of the following criteria:
• •* Translocation t(8;14)
• •* Blasts have surface immunoglobulins
• •* CD10 positive
• •* Patients with third or greater medullary relapse or refractory disease (other than primary induction failures) receive busulfan/melphalan conditioning regimen
• •* Chronic myelogenous leukemia, meeting criteria for 1 of the following:
• •* Accelerated phase
• •* Chronic phase if 1 year from diagnosis without a matched unrelated bone marrow donor AND unresponsive to or unable to tolerate interferon
• •* Blast crisis, defined as greater than 30% promyelocytes plus blasts in bone marrow
• •* Patients receive busulfan/melphalan conditioning regimen
• •* Acute undifferentiated leukemia (AUL), infant leukemia, or biphenotypic leukemia
• •* Patients with third or greater medullary relapse or refractory disease (other than primary induction failures) receive busulfan/melphalan conditioning regimen
• •* Juvenile myelomonocytic leukemia meeting the following criteria:
• •* No Philadelphia chromosome
• •* Bone marrow blasts less than 30%
• •* Peripheral blood monocytes greater than 1,000/mm\^3
• •* At least 2 of the following:
• •* Peripheral blood spontaneous growth and/or sargramostim (GM-CSF) hypersensitivity
• •* Increased hemoglobin F for age
• •* Clonal abnormalities (e.g., monosomy 7 or RAS mutations)
• •* Peripheral blood with myeloid precursors
• •* WBC greater than 10,000/mm\^3
• •* Myelodysplastic syndromes defined by the following:
• •* Refractory anemia (RA)
• •* RA with ringed sideroblasts
• •* RA with excess blasts (RAEB)
• •* RAEB in transformation
• •* Chronic myelomonocytic leukemia
• •* Paroxysmal nocturnal hemoglobinuria
• •* Hodgkin's lymphoma or non-Hodgkin's lymphoma beyond first CR or primary induction failures AND chemosensitive (greater than 50% reduction in tumor mass size)
• •* Inborn error of metabolism including, but not limited to, Hurler's syndrome, adrenoleukodystrophy (ALD), Maroteaux-Lamy syndrome, globoid cell leukodystrophy, metachromatic leukodystrophy, fucosidosis, or mannosidosis
• •* For ALD patients over age 5, IQ must be at least 80
• •* For all other patients over age 5, IQ must be at least 70
• •* For all patients age 5 and under, developmental quotient or clinical neurodevelopmental examination should demonstrate potential for stabilization at a level of functioning where continuous life support (e.g., mechanical ventilation) would not be predicted to be required in the year after transplantation
• •* Combined immune deficiencies including, but not limited to:
• •* Severe combined immunodeficiency (SCID) requiring cytoreduction
• •* Wiskott-Aldrich syndrome
• •* Leukocyte adhesion defect
• •* Chediak-Higashi disease
• •* X-linked lymphoproliferative disease
• •* Adenosine deaminase deficiency
• •* Purine nucleoside phosphorylase deficiency
• •* X-linked SCID
• •* Common variable immune deficiency
• •* Nezelof's syndrome
• •* Cartilage hair hypoplasia
• •No dyskeratosis congenita
• •No ALL, AML, AUL, or biphenotypic leukemia in third or higher medullary relapse or refractory disease other than primary induction failure
• •No primary myelofibrosis or myelofibrosis grade 3 or worse
• •No active CNS leukemia involvement (CSF with WBC greater than 5/mm\^3 and malignant cells on cytospin)
• •No consenting 5/6 or 6/6 HLA-matched related donor available
• •3-6/6 HLA-matched unrelated umbilical cord blood donor available
• •PATIENT CHARACTERISTICS:
• •Age:
• •See Disease Characteristics
• •18 and under
• •Performance status:
• •Karnofsky 70-100%, if age 16 to 18
• •Lansky 50-100%, if under age 16
• •Life expectancy:
• •Not specified
• •Hematopoietic:
• •See Disease Characteristics
• •Hepatic:
• •Bilirubin less than 2.5 mg/dL
• •SGOT less than 5 times upper limit of normal
• •Renal:
• •Creatinine normal for age OR
• •Creatinine clearance or glomerular filtration rate greater than 50% lower limit of normal for age
• •Cardiovascular:
• •If symptomatic:
• •* LVEF greater than 40% (or shortening fraction greater than 26%) and improves with exercise OR
• •* Shortening fraction greater than 26%
• •Pulmonary:
• •If symptomatic:
• •* DLCO, FEV\_1, and FEC greater than 45% predicted OR
• •* Oxygen saturation greater than 85% on room air
• •Other:
• •Not pregnant or nursing
• •Negative pregnancy test
• •Fertile patients must use effective contraception
• •HIV negative
• •No uncontrolled viral, bacterial, or fungal infection
• •PRIOR CONCURRENT THERAPY:
• •Biologic therapy:
• •See Disease Characteristics
• •At least 1 year since prior allogeneic stem cell transplantation (SCT) with cytoreductive preparative therapy
• •At least 6 months since prior autologous SCT
• •No concurrent thrombopoietic growth factors
• •Chemotherapy:
• •See Disease Characteristics
• •See Biologic therapy
• •Endocrine therapy:
• •Not specified
• •Radiotherapy:
• •Not specified
• •Surgery:
• •Not specified