Non-Ablative Allo HSCT For Hematologic Malignancies or SAA

Inclusion Criteria

• •DISEASE CHARACTERISTICS:
• •Histologically proven high-risk hematologic malignancy
• •* Acute non-lymphocytic leukemia (ANLL) after induction failure, or in first complete remission (CR) with high-risk features, including any of the following:
• •* Stem cell or biphenotypic classification (AML-M0)
• •* Erythroleukemia (AML-M6)
• •* Acute megakaryocytic leukemia (AML-M7)
• •* Cytogenetic markers indicative of poor prognosis
• •* Failure to achieve CR after standard induction therapy
• •* Acute lymphocytic leukemia (ALL) or ANLL in relapse or second or subsequent remission
• •* Chronic myelogenous leukemia (CML) in chronic or accelerated phase
• •* Patients with CML in blast crisis are eligible after reinduction chemotherapy places them in chronic phase
• •* High-risk ALL in first CR with high risk defined by presence of t(4;11), t(9;22) translocation, hyperleukocytosis (initial WBC greater than 30,000/mm\^3), or failure to achieve CR by day 28 after standard induction
• •* No T-cell ALL or t(8;14) positive B-cell ALL in first remission with hyperleukocytosis
• •* Myelodysplastic syndrome by peripheral blood smear and bone marrow examination
• •* Refractory to medical management OR
• •* Cytogenetic abnormalities predictive of transformation into acute leukemia including 5q-, 7q-, monosomy 7, and trisomy 8 OR
• •* Evidence of evolution to AML (e.g., refractory anemia with excess blasts (RAEB) or RAEB in transformation)
• •* Multiple myeloma, non-Hodgkin's lymphoma (NHL), ANLL, or ALL with recurrent disease after autologous stem cell transplantation (SCT)
• •* At least 3 months since prior autologous SCT
• •* Hodgkin's lymphoma, NHL, or multiple myeloma beyond first CR or primary induction failures whose disease has demonstrated sensitivity to pre-transplantation cytoreduction (defined as greater than 50% reduction in tumor burden)
• •* Mantle zone NHL allowed after induction therapy
• •* Myeloproliferative disorder that is non-responsive to medical management and requires allografting, unless evidence of grade 3 or worse myelofibrosis on marrow biopsy OR
• •Histologically proven acquired severe aplastic anemia (SAA) that is recurrent or unresponsive after anti-thymocyte globulin and/or cyclosporine
• •* SAA defined by at least 2 of the following conditions:
• •* Granulocyte count less than 500/mm\^3
• •* Platelet count less than 20,000/mm\^3
• •* Absolute reticulocyte count less than 20,000/mm\^3 after correction for hematocrit
• •Ineligible for full ablative conditioning due to any of the following conditions:
• •* Prior extensive therapy (more than 2 salvage chemotherapy regimens and/or autologous transplantation)
• •* Over age 55 OR
• •* Under age 55 with comorbid disease (e.g., suboptimal cardiac, pulmonary, or renal function and/or prior life-threatening infection)
• •HLA-A, B, and DR phenotypically identical sibling donor OR
• •HLA-A, B, and DR identical genetically matched unrelated donor
• •No ANLL in first CR (less than 5% blasts in marrow) with translocations t(8;21) and inv(16) unless failed first-line induction therapy OR
• •No ANLL in first CR (less than 5% blasts in marrow) with translocations t(15;17) abnormality unless failed first-line induction therapy OR molecular evidence of persistent disease
• •No active CNS disease
• •PATIENT CHARACTERISTICS:
• •Age:
• •0 to 70
• •Performance status:
• •Zubrod 0-1
• •Karnofsky 80-100%
• •Life expectancy:
• •At least 3 months
• •Hematopoietic:
• •See Disease Characteristics
• •Hepatic:
• •ALT/AST no greater than 4 times normal
• •Bilirubin no greater than 2.0 mg/dL
• •Renal:
• •See Disease Characteristics
• •Creatinine clearance at least 50 mL/min
• •Cardiovascular:
• •See Disease Characteristics
• •Shortening fraction or ejection fraction at least 40% of normal for age by echocardiogram or radionuclide scan
• •No clinically significant comorbid illnesses (e.g., myocardial infarction or cerebrovascular accident)
• •Pulmonary:
• •See Disease Characteristics
• •FVC and FEV\_1 at least 60% of predicted for age
• •DLCO at least 60% of predicted for adults
• •Other:
• •No severe neurosensory symptoms (i.e., peripheral neuropathy)
• •HIV negative
• •Active infection allowed if controlled by appropriate drug therapy
• •Not pregnant or nursing
• •Negative pregnancy test
• •PRIOR CONCURRENT THERAPY:
• •Biologic therapy:
• •See Disease Characteristics
• •Chemotherapy:
• •See Disease Characteristics
• •Endocrine therapy:
• •Not specified
• •Radiotherapy:
• •Not specified
• •Surgery:
• •Not specified
• •Other:
• •Recovered from prior therapy
• •No concurrent investigational agents unless approved by protocol investigators