Donor Umbilical Cord Blood Transplant in Treating Patients With Advanced Hematological Cancer or Other Disease

You may be eligible if

• DISEASE CHARACTERISTICS:
• Diagnosis of advanced hematologic malignancy or other disease not curable by conventional chemotherapy, including any of the following:
• * Acute myeloid leukemia in complete remission (CR)\* (as defined by hematologic recovery, \< 5% blasts in the bone marrow by morphology, and a cellularity of \> 15%), meeting one of the following criteria:
• * In first complete remission (CR1) AND has high-risk disease as evidenced by any of the following:
• * Preceding myelodysplastic syndromes (MDS)
• * High-risk cytogenetics (e.g., monosomy 5 or 7, or as defined by referring institution treatment protocol)
• * Required \> 2 courses of therapy to obtain CR
• * Erythroblastic or megakaryocytic leukemia
• * In second CR (CR2) or beyond
• * Acute lymphoblastic leukemia in CR\* (as defined by hematologic recovery, \< 5% blasts in the bone marrow by morphology, and a cellularity of \> 15%), meeting one of the following criteria:
• * In CR1 AND has high-risk disease as evidenced by any of the following:
• * t(9;22), t(1;19), t(4;11), or other MLL rearrangements
• * Hyplodiploid
• * Required \> 1 course of therapy to obtain CR
• * Beyond CR2
• * Chronic myelogenous leukemia (CML)
• * All types are allowed (except refractory blast crisis CML)
• * Patients in chronic phase CML must have failed or been intolerant to prior imatinib mesylate (Gleevec) or other tyrosine kinase inhibitors
• * MDS
• * Any subtype allowed (including refractory anemia \[RA\])
• * Severe pancytopenia or complex cytogenetics
• * Blasts must be \< 5% (if blasts are ≥ 5%, pre-transplant induction therapy is required to reduce blast count to \< 5%)
• * Large cell lymphoma, Hodgkin lymphoma, or multiple myeloma, meeting one of the following criteria:
• * Chemotherapy-sensitive disease that has failed prior therapy
• * Patients with large cell lymphoma or Hodgkin lymphoma must not have progressive disease during salvage therapy (stable disease allowed provided it is non-bulky)
• * Ineligible for an autologous stem cell transplant
• * Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), marginal zone B-cell lymphoma, or follicular lymphoma that has progressed after ≥ 2 prior therapies
• * Patients with bulky disease should be considered for debulking chemotherapy prior to transplant
• * Patients with refractory disease are eligible provided disease is non-bulky AND an estimated tumor doubling time is ≥ 1 month
• * Lymphoplasmacytic lymphoma, mantle cell lymphoma, or prolymphocytic leukemia
• * Chemotherapy-sensitive disease that was previously treated with initial therapy
• * Patients with mantle cell lymphoma must not have progressive disease during salvage therapy (stable disease allowed provided it is non-bulky)
• * Mycosis fungoides and Sezary syndrome
• * Bone marrow failure syndromes, except for Fanconi anemia
• * Myeloproliferative syndromes NOTE: \*Patients for whom adequate marrow/biopsy specimens can not be obtained to determine remission status by morphologic assessment must have fulfilled criteria of remission (\< 5% blasts by flow cytometry and recovery of peripheral blood counts with no circulating blasts)
• Ineligible for autologous stem cell transplant due to any of the following:
• * Prior autologous stem cell transplant
• * Inadequate autologous stem cell harvest
• * Inability to withstand a myeloablative preparative regimen
• * Clinically aggressive/high-risk disease
• No evidence of progressive disease by imaging modalities or biopsy (persistent PET scan activity allowed provided there are no CT scan changes indicating progression)
• Acute leukemia that is refractory, persistent, or relapsed (defined as \> 5% blasts in normocellular bone marrow) allowed provided patient was rendered aplastic either by induction chemotherapy or radioimmunoconjugated monoclonal antibody therapy
• Patients with stable disease are eligible provided the largest residual nodal mass is approximately \< 5 cm (largest residual mass must represent a 50% reduction and be approximately \< 7.5 cm for patients who have responded to prior therapy)
• No active CNS malignancy
• Umbilical cord blood (UCB) donor available
• * UCB graft matched at 4/6 HLA-A, -B, and -DRB1 antigens with the recipient
• * May include 0-2 antigen mismatches at the A, B, or DRB1 loci
• * Unit selection based on cryopreserved nucleated cell dose and HLA-A, -B, and -DRB1 using intermediate resolution A, B antigen and DRB1 allele typing
• * If 2 UCB units are required to reach the target cell dose, each unit must be a 3/6 HLA-A, -B, and -DRB1 antigen match to each other, as well as a 4/6 antigen match to the recipient
• * No 5-6/6 HLA-A, -B, and -DRB1 matched sibling donor available
• PATIENT CHARACTERISTICS:
• Karnofsky performance status (PS) 60-100% OR Lansky PS 50-100%
• Creatinine ≤ 2.0 mg/dL (adults) OR creatinine clearance \> 40 mL/min (pediatrics)
• * Adult patients with a creatinine \> 1.2 mg/dL or a history of renal dysfunction must have an estimated creatinine clearance of \> 40 mL/min
• Not pregnant or nursing
• Negative pregnancy test
• LVEF ≥ 35%
• DLCO \> 30% predicted
• No requirement for O\_2
• No decompensated congestive heart failure
• No uncontrolled arrhythmia
• None of the following liver diseases or conditions:
• * Fulminant liver failure
• * Cirrhosis with evidence of portal hypertension or bridging fibrosis
• * Alcoholic hepatitis
• * Esophageal varices
• * History of bleeding esophageal varices, hepatic encephalopathy, or correctable hepatic synthetic dysfunction as evidenced by prolongation of the prothrombin time
• * Ascites related to portal hypertension
• * Bacterial or fungal abscess
• * Biliary obstruction
• * Chronic viral hepatitis with total serum bilirubin \> 3 mg/dL
• * Symptomatic biliary disease
• Recent mold infection (e.g., Aspergillus) allowed provided patient received ≥ 30 days of appropriate treatment AND infection is controlled and cleared by Infectious Disease
• No evidence of HIV infection or known HIV-positive serology
• No uncontrolled viral or bacterial infection
• PRIOR CONCURRENT THERAPY:
• See Disease Characteristics
• At least 3 months since prior myeloablative stem cell transplantation