Bone Marrow Transplantation in Treating Patients With Hematologic Cancer

Inclusion Criteria

• •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