Combination Chemotherapy, Total Body Irradiation, and Donor Blood Stem Cell Transplant in Treating Patients With Secondary Myelofibrosis

Inclusion Criteria

• •Diagnosis of primary of secondary myelofibrosis with transplant indication by Dynamic International Prognostic Scoring System (DIPSS)-plus (\> intermediate-1)
• •Patients \>= age 50 must have a comorbidity score (hematopoietic cell transplant-comorbidity index \[HCT-CI\]) \< 4 (Sorror)
• •Patients can be in chronic phase (CP) with bone marrow (BM) blast count =\< 15% as long as no evidence of disease acceleration per principal investigator (PI) and treating physician's opinion or after progression to acute myeloid leukemia (AML) and achieved =\< 5% BM blasts (morphologic complete remission \[CR\] prior to transplant)
• •Lack of an human leukocyte antigen (HLA) matched donor or need to proceed fast to transplantation when a patient does not have an immediately available matched unrelated donor (typed by high-resolution in the registry)
• •Performance status \>= 70% (Karnofsky); patients \> 50 years should have adequate cognitive function; any concerns regarding cognitive function should be addressed by a geriatrician/neurologist
• •Alanine aminotransferase (ALT)/aspartate aminotransferase (AST)/bilirubin =\< 5 X upper limit of normal (ULN)
• •Measured creatinine clearance \> 60 mls/min
• •Left ventricular ejection fraction (LVEF) \>= 50%
• •Corrected carbon monoxide diffusing capability (DLCOc) \>= 50%
• •No active infections
• •Prior treatment with JAK2 inhibitor therapy is not excluded; a JAK2 inhibitor will need to be stopped 1-2 days prior to starting conditioning regimen
• •DONOR: Documented informed consent per local, state and federal guidelines
• •DONOR: Genotypically haploidentical as determined by HLA typing
• •* Preferably a non-maternal HLA haploidentical relative due to data of high incidence of graft failure with use of maternal HLA haploidentical cells
• •* Eligible donors include biological parents, siblings or half-siblings, children, or cousins in rare instances
• •DONOR: Absence of pre-existing donor-specific anti-HLA antibodies (DSA) in the recipient; Patients with pre-existing DSA could undergo desensitization per City of Hope (COH) standard operating procedures \[SOP\] and should have DSA \< MFI of 2000 prior to conditioning at discretion of PI
• •DONOR: Infectious disease screening performed within 30 days prior to stem cell mobilization per federal guidelines and is:
• •* Seronegative for HIV 1+2 antibody (Ab) and/or HIV polymerase chain reaction (PCR), human T-cell leukemia virus (HTLV) I/II Ab, hepatitis B virus surface antigen (HBsAg), hepatitis B virus surface antibody (HBcAb), hepatitis C virus (HCV) Ab
• •* Negative rapid plasma reagin (RPR) for syphilis
• •DONOR: Women of childbearing potential (WOCBP): Urine pregnancy testing performed within 7 days prior to stem cell mobilization
• •DONOR: Is approved and completed evaluation prior to recipient initiation of the preparative regimen per institutional guidelines