Inclusion Criteria:

Meeting the definition of standard risk or high risk Fanconi anemia as defined in the next
two sections:

- Standard risk patients must be <18 years of age with a diagnosis of Fanconi anemia
with aplastic anemia (AA), myelodysplastic syndrome without excess blasts, or high
risk genotype as defined below:

- Aplastic anemia is defined as having at least one of the following when not
receiving growth factors or transfusions:

- platelet count <20 * 10^9/L

- ANC <5 * 10^8/L

- Hemoglobin <8 g/dL

- Myelodysplastic syndrome (MDS) with multilineage dysplasia with or without
chromosomal anomalies

- High risk genotype (e.g. IVS-4 or exon 14 FANCC mutations, or BRCA1 or 2
mutations)

- High risk patients must have one or more of the following high risk features:

- Advanced MDS (≥ 5% blast) or acute leukemia

- Require additional HSCT for graft failure

- History at any time of systemic fungal or gram negative infection

- Severe renal disease with a creatinine clearance <40 mL/min

- Age > 18 years

- Very high risk patients must have Advanced MDS (≥ 5% blast) or acute leukemia after
initial hematopoietic stem cell transplant (HSCT)

- Patients must have an appropriate source of stem cells. Patients and donors will be
typed for HLA-A, B, C and DRB1 using high resolution molecular typing.

- Adequate major organ function including:

- Cardiac: ejection fraction >45%

- Hepatic: bilirubin, AST or ALT, ALP <5 x normal

- Karnofsky performance status >70% or Lansky >50 (if < 16 years of age)

- Women of child-bearing age must be using adequate birth control and have a negative
pregnancy test.

- Written consent.

Exclusion Criteria:

- Available HLA-genotypically identical related donor in standard risk patients.

- Active central nervous system (CNS) leukemia at time of study enrollment.

- History of squamous cell carcinoma of the head/neck/cervix within previous 2 years.

- Prior radiation therapy that prevents further total body irradiation (TBI).