Treosulfan, Fludarabine Phosphate, and Total-Body Irradiation Before Donor Stem Cell Transplant in Treating Patients With High-Risk Acute Myeloid Leukemia, Myelodysplastic Syndrome, Acute Lymphoblastic Leukemia

Exclusion Criteria

• •Receiving umbilical cord blood
• •With impaired cardiac function as evidenced by ejection fraction \< 35% or cardiac insufficiency requiring treatment or symptomatic coronary artery disease
• •With impaired pulmonary function as evidenced by partial pressure of oxygen (pO2) \< 70 mm Hg and diffusing capacity of the lung for carbon monoxide (DLCO) \< 70% of predicted or pO2 \< 80 mm Hg and DLCO \< 60% of predicted; or receiving supplementary continuous oxygen
• •With impaired renal function as evidenced by creatinine-clearance \< 50% for age, weight, height or serum creatinine \> 2x upper normal limit or dialysis-dependent
• •With hepatic dysfunction as evidenced by total bilirubin or aspartate aminotransferase (AST) or alanine aminotransferase (ALT) \> 2.0 x upper normal limit or evidence of synthetic dysfunction or severe cirrhosis
• •With active infectious disease requiring deferral of conditioning, as recommended by an Infectious Disease specialist
• •With human immunodeficiency virus (HIV)-positivity or active infectious hepatitis because of possible risk of lethal infection when treated with immunosuppressive therapy
• •With central nervous system (CNS) leukemic involvement not clearing with intrathecal chemotherapy and/or cranial radiation prior to initiating conditioning (day -6)
• •With life expectancy severely limited by diseases other than malignancy
• •Women who are pregnant or lactating because of possible risk to the fetus or infant
• •With known hypersensitivity to treosulfan and/or fludarabine
• •Receiving another experimental drug within 4 weeks before initiation of conditioning (day -6)
• •Unable to give informed consent (if \> 18 years) or with a legal guardian (if \< 18 years) unable to give informed consent
• •Ineligible donors will be those:
• •* Deemed unable to undergo marrow harvesting or PBSC mobilization and leukapheresis
• •* Who are HIV-positive
• •* With active infectious hepatitis
• •* Females with a positive pregnancy test
• •* Unable to give informed consent (if \> 18 years) or with a legal guardian (if \< 18 years) unable to give informed consent