OBJECTIVES:
* Decrease the conditioning-related toxicity of cyclophosphamide without decreasing the engraftment rate to \< 90% in patients undergoing allogeneic bone marrow transplantation for Fanconi's anemia.
OUTLINE: This is a multicenter, dose-finding study of cyclophosphamide.
* Nonmyeloablative conditioning regimen: Patients receive cyclophosphamide IV on days -5 to -2.
Cohorts of 5-10 patients receive decreasing doses of cyclophosphamide until the optimal dose (OD) is determined. The OD is defined as the dose at which ≥ 4 of 5 patients achieve engraftment and \< 1 of 10 patients experiences dose-limiting toxicity.
* Allogeneic bone marrow transplantation (BMT): Patients undergo allogeneic BMT on day 0.
* Graft-vs-host-disease (GVHD) prophylaxis: Patients receive cyclosporine orally or IV twice daily beginning on day -1 and continuing until day 49, followed by a taper on days 50-180 in the absence of GVHD. Patients also receive methotrexate IV on days 1, 3, 6, and 11.
After completion of study treatment, patients are followed periodically for 5 years.
PROJECTED ACCRUAL: A total of 27 patients will be accrued for this study.
