OBJECTIVES:
Primary
* To determine the maximum tolerated dose of intensity-modulated total marrow and lymph node irradiation (TMLI) using helical tomotherapy in combination with a reduced-intensity preparative regimen comprising fludarabine phosphate and melphalan in patients undergoing allogeneic hematopoietic stem cell transplantation for advanced, relapsed or refractory hematological malignancies.
* To describe the toxicities of escalating doses of TMLI in these patients.
Secondary
* To describe the frequency of clinical response in patients treated with this regimen.
* To describe the frequency of primary and secondary engraftment failure in patients treated with this regimen.
* To describe the time to neutrophil and platelet engraftment in patients treated with this regimen.
* To describe the incidence of acute and chronic graft-versus-host disease in patients treated with this regimen.
* To describe the overall survival of patients treated with this regimen.
* To describe the progression-free survival of patients treated with this regimen.
OUTLINE: This is a dose-escalation study of intensity-modulated total marrow and lymph node irradiation (TMLI).
* Intensity-modulated radiation therapy: Patients undergo TMLI to skeletal bone/marrow, major lymph node chains, spleen, and liver using helical tomotherapy twice daily on days -6 to -3.
* Reduced-intensity preparative regimen: Patients receive fludarabine phosphate IV on days -6 to -2 and melphalan IV on day -1.
* Hematopoietic stem cell transplantation (HSCT): Patients undergo allogeneic HSCT on day 0.
After completion of study treatment, patients are followed periodically.
