Non-Myeloablative Allogeneic Peripheral Blood Stem Cell Transplantation for Hematologic Malignancies and Aplastic Anemia

Inclusion Criteria

DISEASE CHARACTERISTICS:

- Diagnosis of aplastic anemia

- Severe disease

- Failed at least 1 course of standard immunosuppressive regimen with cyclosporine
and anti-thymocyte globulin OR

- Histologically confirmed hematologic malignancy including the following:

- Acute leukemia

- Any of the following types:

- Acute myeloid leukemia (AML) with antecedent myelodysplastic syndromes

- Secondary AML

- AML with high-risk cytogenetic abnormalities

- Acute lymphoblastic leukemia with high-risk cytogenetic abnormalities

- Resistant or recurrent disease after combination chemotherapy with at least
1 standard regimen OR

- In first remission at high risk of relapse

- Chronic myelogenous leukemia

- Chronic phase meeting at least 1 of the following criteria:

- Failed imatinib mesylate

- Failed interferon after at least 6 months of treatment with minimum of
21 million units of interferon per week

- Unable to tolerate interferon

- Accelerated phase (blasts less than 20%)

- Myeloproliferative and myelodysplastic syndromes

- Myelofibrosis (after splenectomy)

- Refractory anemia

- Refractory anemia with excess blasts

- Chronic myelomonocytic leukemia

- Lymphoproliferative disease

- Chronic lymphocytic leukemia

- Symptomatic disease after first-line chemotherapy

- Low-grade non-Hodgkin's lymphoma (recurrent or persistent)

- Symptomatic disease after first-line chemotherapy

- Multiple myeloma

- Progressive disease after autologous stem cell transplantation

- Waldenstrom's macroglobulinemia

- Failed 1 standard regimen

- Non-Hodgkin's lymphoma meeting the following criteria:

- Intermediate or high grade

- Controlled and chemosensitive disease

- First remission lymphoblastic or small non-cleaved cell lymphoma at high
risk of relapse

- Hodgkin's lymphoma

- Relapsed and chemosensitive disease

- Not eligible for standard myeloablative allogeneic stem cell transplantation

- Availability of any of the following donor types:

- Related donor matched at 5 or 6 HLA antigens (A, B, DR)

- Unrelated donor fully matched by molecular analysis at A, B, DRB1, and DQB1 loci

- Single antigen mismatch at C allowed

- Cord blood that is 4, 5, or 6 match with recipient HLA antigens (A, B, DR) NOTE:
No syngeneic donors permitted

- No uncontrolled CNS disease (for hematologic malignancies) NOTE: A new classification
scheme for adult non-Hodgkin's lymphoma has been adopted by PDQ. The terminology of
"indolent" or "aggressive" lymphoma will replace the former terminology of "low",
"intermediate", or "high" grade lymphoma. However, this protocol uses the former
terminology.

PATIENT CHARACTERISTICS:

Age

- 5 to 75 (if related donor transplantation)

- 5 to 60 (if unrelated donor transplantation)

Performance status

- Karnofsky > 50%

Life expectancy

- Not specified

Hematopoietic

- Not specified

Hepatic

- Bilirubin less than 3 times normal

- Alkaline phosphatase less than 3 times normal

- AST/ALT less than 3 times normal

- No Child's class B or C liver failure

Renal

- Creatinine clearance greater than 40 mL/min

Cardiovascular

- Cardiac ventricular ejection fraction at least 35% by MUGA

- No cardiovascular disease

Pulmonary

- DLCO at least 40% of predicted, corrected for hemoglobin and/or alveolar ventilation

Other

- Not pregnant or nursing

- Negative pregnancy test

- Fertile patients must use effective contraception

- HIV antibody negative

- No uncontrolled diabetes mellitus

- No active serious infection

- No other disease that would preclude study therapy

- No other concurrent malignancy except non-melanoma skin cancer

- No concurrent serious psychiatric illness

PRIOR CONCURRENT THERAPY:

Biologic therapy

- See Disease Characteristics

- At least 6 months since prior autologous bone marrow transplantation (BMT)

- At least 12 months since prior allogeneic BMT

Chemotherapy

- See Disease Characteristics

- At least 4 weeks since prior chemotherapy

Endocrine therapy

- Not specified

Radiotherapy

- At least 4 weeks since prior radiotherapy

Surgery

- At least 4 weeks since prior surgery