Reduced-Intensity Regimen Before Donor Bone Marrow Transplant in Treating Patients With Myelodysplastic Syndromes

OBJECTIVES: * Determine the complete response rate in patients with myelodysplastic syndromes treated with reduced-intensity allogeneic bone marrow transplantation, including photopheresis, total body irradiation, and pentostatin. * Determine the disease-free and overall survival of patients treated with this regimen. * Determine the engraftment rate of donor cells in patients treated with this regimen. * Determine the extent and duration of acute and chronic graft-versus-host disease in patients treated with this regimen. * Determine the toxicity of this regimen in these patients. OUTLINE: This is a single-arm, two-stage, multicenter phase II study. * Preparative Regimen: Patients undergo photopheresis using methoxsalen on days -7 and -6 and receive pentostatin intravenously (IV )continuously on days -5 and -4. Total body irradiation is administered on days -3 and -2 for a total of 3 doses. * Transplantation: Allogeneic bone marrow or peripheral blood stem cells are infused on day 0. * Acute graft-vs-host-disease (GVHD) prophylaxis: Patients receive cyclosporine IV on days -1 to 30 and then orally every 12 hours. Cyclosporine dose is then tapered beginning after day 50 and continuing for 6 months in the absence of GVHD. Once cyclosporine dose is significantly decreased, oral mycophenolate mofetil (MMF) is then administered twice a day. MMF dose is then tapered for 12 months in the absence of GVHD. Patients also receive methotrexate IV on days 1 and 3. Patients are followed every 3 months for 2 years, every 6 months for 3 years, and then annually thereafter. PROJECTED ACCRUAL: A total of 33 patients would be accrued for this study within 2.1 years.