Mycophenolate Mofetil and Cyclosporine in Reducing Graft-Versus-Host Disease in Patients With Hematologic Malignancies or Metastatic Kidney Cancer Undergoing Donor Stem Cell Transplant

* Low grade NHL- with \< 6 month duration of complete remission (CR) between courses of conventional therapy

* Mantle cell NHL-may be treated in first CR

* Chronic lymphocytic leukemia (CLL)- Must be refractory to fludarabine; patients who fail to have a complete or partial response after therapy with a regimen containing fludarabine (or another nucleoside analog, e.g. 2-cladribine \[CDA\], pentostatin) or experience disease relapse within 12 months after completing therapy with a regimen containing fludarabine (or another nucleoside analog)

* Hodgkin disease (HD)- must have received and failed frontline therapy

* Multiple myeloma (MM)- must have received prior chemotherapy; consolidation of chemotherapy by autografting prior to nonmyeloablative HCT is permitted

* Acute myeloid leukemia (AML)- must have \< 5% marrow blasts at the time of transplant.

* Acute lymphocytic leukemia (ALL)- must have \< 5% marrow blasts at the time of transplant

* Chronic myelogenous leukemia (CML)- Patients will be accepted in chronic phase or accelerated phase; patients who have received prior autografts after high dose therapy or have undergone intensive chemotherapy with filgrastim (G-CSF)-mobilized peripheral blood mononuclear cells (G-PBMC) autologous or conventional HCT for advanced CML may be enrolled provided they are in CR or CP and have \< 5% marrow blasts at time of transplant

* Myelodysplastic syndrome (MDS)/myeloproliferative disorder (MPD)- Only patients with MDS/refractory anemia (RA) or MDS/refractory anemia with ringed sideroblasts (RARS) will be eligible for this protocol; additionally patients with myeloproliferative syndromes (MPS) will be eligible; those patients with MDS or MPS with \> 5% marrow blasts (including those with transformation to AML) must receive cytotoxic chemotherapy and achieve \< 5% marrow blasts at time of transplant

* Renal cell carcinoma- Must have evidence of disease not amenable to surgical cure or history of or active metastatic disease by radiological and histologic criteria

DONOR: FHCRC matching allowed will be grade 1.0 to 2.1: Unrelated donors who are prospectively:

* Matched for human leukocyte antigen (HLA)-A, B, C, major histocompatibility complex, class II, DR beta 1 (DRB1) and major histocompatibility complex, class II, DQ beta 1 (DQB1) by high resolution typing;

* Only a single allele disparity will be allowed for HLA-A, B, or C as defined by high resolution typing

DONOR: A positive anti-donor cytotoxic crossmatch is an absolute donor exclusion

DONOR: Patient and donor pairs homozygous at a mismatched allele in the graft rejection vector are considered a two-allele mismatch, i.e., the patient is A\*0101 and the donor is A\*0201, and this type of mismatch is not allowed

DONOR: G-PBMC only will be permitted as a HSC source on this protocol

Patients with rapidly progressive intermediate or high grade NHL

Renal cell carcinoma patients

* With expected survival of less than 6 months

* Disease resulting in severely limited performance status (\< 70%)

* Any vertebral instability

* History of brain metastases

Central nervous system (CNS) involvement with disease refractory to intrathecal chemotherapy

Fertile men or women unwilling to use contraceptive techniques during and for 12 months following treatment

Females who are pregnant

Patients with non-hematological tumors except renal cell carcinoma

Fungal infections with radiological progression after receipt of amphotericin B or active triazole for greater than 1 month

Cardiac ejection fraction \< 35%; ejection fraction is required if there is a history of anthracycline exposure or history of cardiac disease

Diffusing capacity of the lung for carbon monoxide (DLCO) \< 40% and/or receiving supplementary continuous oxygen

The FHCRC PI of the study must approve of enrollment of all patients with pulmonary nodules

Patients with clinical or laboratory evidence of liver disease would be evaluated for the cause of liver disease, its clinical severity in terms of liver function, and the degree of portal hypertension; patients will be excluded if they are found to have fulminant liver failure, cirrhosis of the liver with evidence of portal hypertension, alcoholic hepatitis, esophageal varices, a history of bleeding esophageal varices, hepatic encephalopathy, uncorrectable hepatic synthetic dysfunction evinced by prolongation of the prothrombin time, ascites related to portal hypertension, bridging fibrosis, bacterial or fungal liver abscess, biliary obstruction, chronic viral hepatitis with total serum bilirubin \> 3 mg/dL, and symptomatic biliary disease

Karnofsky scores \< 60 (except renal cell carcinoma \[RCC\])

Patients with \> grade II hypertension by Common Toxicity Criteria (CTC)

Human immunodeficiency virus (HIV) positive patients

The addition of cytotoxic agents for "cytoreduction" with the exception of hydroxyurea and imatinib mesylate will not be allowed within two weeks of the initiation of conditioning

DONOR: Marrow donors

DONOR: Donors who are HIV-positive and/or, medical conditions that would result in increased risk for G-CSF mobilization and harvest of G-PBMC

What this study is about