Organ-Sparing Marrow-Targeted Irradiation Before Stem Cell Transplant in Treating Patients With High-Risk Hematologic Malignancies

Inclusion Criteria

• •Patients with a diagnosis of acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), or myelodysplastic syndromes (MDS) with fewer than 10% myeloblasts or lymphoblasts in the bone marrow and no blasts in the peripheral blood on morphologic analysis performed within 30 days of start of the conditioning regimen; if remission bone marrow is available beyond 30 days a new bone marrow evaluation is required to assess remission status
• •* The diagnosis of AML, ALL, or MDS will be based on World Health Organization (WHO) criteria
• •* Pre-transplant bone marrow sample must be evaluable for assessment of remission status (i.e. aspirate smear containing particles and/or evaluable bone marrow core biopsy)
• •* If the patient has an intra-abdominal chloroma on presentation, and has a partial response or complete response to treatment (size reduction of chloroma and marrow blast \< 10%), the patient is eligible; however the chloroma must be included as part of the treatment target
• •For patients receiving treatment of their AML, MDS or ALL prior to transplantation:
• •* Interval between the start of a cycle of conventional cytotoxic chemotherapy and the start of conditioning regimen must be at least 30 days
• •* Interval between completing treatment with a hypomethylating agent or other non-cytotoxic chemotherapy and the start of conditioning regimen must be at least 10 days
• •Hematopoietic Cell Transplantation-Specific Comorbidity Index score (HCT-CI) =\< 4 for patients in Cohort 1 and \> 4 for Cohort 2
• •Patient must be able to lie still in full body cast for 45 minutes
• •Must have a suitable donor defined as a sibling matched at 5/6 or 6/6 antigens (human leukocyte antigen \[HLA\]-A, B, and DRB1) or an unrelated volunteer matched at 7/8 or 8/8 HLA alleles (HLA-A, B, C, and DRB1)
• •Signed informed consent
• •DONOR: "High resolution" typing at HLA-A, B, C and DRB1 alleles
• •* Single antigen mismatch for siblings and single allele mismatch for volunteer unrelated donors is acceptable
• •* Donors must be \>= 17 years of age