A Phase II Trial of Non-Myeloablative Conditioning and Transplantation of Partially HLA-Mismatched Bone Marrow for Patients With Hematologic Malignancies

Inclusion Criteria

DISEASE CHARACTERISTICS:

- Diagnosis of 1 of the following hematologic malignancies:

- Acute leukemia

- In second or subsequent complete remission (CR), as defined by absence of
abnormal blast population by flow cytometry

- In first CR with any of the following poor-risk cytogenetic features:

- Alteration of chromosome 5 or 7

- Multiple abnormalities

- Philadelphia chromosome positive

- Chronic phase chronic myelogenous leukemia (CML)

- In first chronic phase and refractory to interferon alfa or imatinib
mesylate

- In second or subsequent chronic phase

- Chronic lymphocytic leukemia, meeting 1 of the following criteria:

- Received prior chemotherapy with a nucleoside analog and had remission
lasting < 6 months

- Received 1 prior therapy and has any of the following high-risk features:

- Cytogenetic abnormalities of 17p, 11q

- Mutations of the Zap70 gene

- Somatically unmutated immunoglobulin heavy chain variable region genes

- Hodgkin's lymphoma

- Ineligible for autologous stem cell transplantation (SCT) due to any of the
following exclusion factors:

- LVEF < 45%

- FEV_1 or FVC < 50% of predicted (75% of predicted in patients with
prior thoracic or mantle radiotherapy)

- Total bilirubin > 2.0 mg/dL (unless documented Gilbert's disease)

- Creatinine > 2.0 mg/dL

- Non-Hodgkin's lymphoma (NHL)

- Low-grade NHL allowed provided patient had a remission duration of < 1 year
after administration of any established, multi-agent chemotherapy regimen
(e.g., CVP, CHOP, or rituximab in combination with CHOP)

- Intermediate- or high-grade NHL allowed provided patient is ineligible for
autologous SCT according to the criteria listed above

- Multiple myeloma

- Myelodysplastic syndromes

- Paroxysmal nocturnal hemoglobinuria

- Chronic myeloproliferative disorders other than CML, including any of the
following:

- Chronic myelomonocytic leukemia

- Agnogenic myeloid metaplasia (or myeloid metaplasia with myelofibrosis),
with hemoglobin < 10 g/dL OR WBC < 4,000/mm^3 or > 30,000/mm^3

- Polycythemia vera or essential thrombocythemia in "spent" phase, with a
history of 2 of the following:

- Marrow fibrosis

- Splenomegaly

- Cytopenia (i.e., absolute neutrophil count < 1,500/mm^3, platelet
count < 100,000/mm^3, hemoglobin < 10 g/dL)

- Polycythemia vera or essential thrombocythemia with transformation to
myelodysplastic syndromes or acute myeloid leukemia (requires treatment to
achieve < 20% blasts in marrow)

- No smoldering myeloma

- Patients with acute myeloid leukemia or myelodysplastic syndromes must have had
comprehensive cytogenetic evaluation of bone marrow specimen during active disease

- Ineligible for or refused bone marrow transplantation from an HLA-matched sibling or
unrelated donor

- Ineligible for or refused autologous SCT

- Must have an HLA mismatched (i.e., 3/6, 4/6, or 5/6) related (first-degree relative)*
donor available

- Donor ≥ 18 years of age NOTE: *Patients with an inherited recombinant HLA
haplotype may receive marrow from the parent in whose gamete the recombination
occurred

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

- 6 months to 70 years

Performance status

- ECOG 0-1

Life expectancy

- Not specified

Hematopoietic

- See Disease Characteristics

Hepatic

- See Disease Characteristics

- Bilirubin < 3.1 mg/dL

Renal

- See Disease Characteristics

Cardiovascular

- See Disease Characteristics

- LVEF ≥ 35%

Pulmonary

- See Disease Characteristics

- FEV_1 or FVC ≥ 40% of predicted in patients without prior thoracic or mantle
radiotherapy (60% of predicted in patients with prior thoracic or mantle
radiotherapy)

Other

- Not pregnant or nursing

- Negative pregnancy test

- Fertile patients must use effective contraception

- HIV negative

- Geographically accessible

- No debilitating medical or psychiatric illness that would preclude giving informed
consent or receiving optimal treatment or follow-up

PRIOR CONCURRENT THERAPY:

Biologic therapy

- See Disease Characteristics

- No prior transfusions from donor

Chemotherapy

- See Disease Characteristics

Endocrine therapy

- Not specified

Radiotherapy

- See Disease Characteristics

Surgery

- Not specified