Phase I-II Study of Escalating Doses of Large Field Image-Guided Intensity Modulated Radiation Therapy (IMRT) Using Helical Tomotherapy in Combination With Etoposide (VP16) and Cytoxan as a Preparative Regimen for Allogeneic Hematopoietic Stem Cell (HSC) Transplantation for Patients With Poor Risk Acute Lymphocytic Leukemia (ALL) or Poor Risk Acute Myelogenous Leukemia (AML)

Inclusion Criteria:

- Patients with acute lymphocytic leukemia or acute myelogenous leukemia who are not in
first or second remission (i.e., after failing remission induction therapy or in
relapse or beyond second remission)

- All candidates for this study must have an HLA (A, B, C, DR) identical sibling who is
willing to donate bone marrow or primed blood stem cells or a 10/10 allele matched
unrelated donor; all ABO blood group combinations of the donor/recipient are
acceptable since even major ABO compatibilities can be dealt with by various
techniques

- Prior therapy with VP-16, Busulfan, and Cytoxan is allowed

- A cardiac exam with a electrocardiogram showing no ischemic changes or abnormal
rhythm and an ejection fraction of >= 50% established by multi gated acquisition scan
(MUGA) or echocardiogram

- Patients must have a serum creatinine of less than or equal to 1.2 or creatinine
clearance >= 80 ml/min

- Bilirubin of less than or equal to 1.5

- Serum glutamic oxaloacetic transaminase (SGOT) less than 5 times the upper limit of
normal

- Serum glutamic pyruvic transaminase (SGPT) less than 5 times the upper limit of
normal

- Pulmonary functioning tests including diffusing capacity of carbon monoxide (DLCO)
will be performed; forced expiratory volume in one second (FEV1) and DLCO should be
greater than 50% of the predicted normal value

- The time from the end last induction or reinduction attempt should be >= 14 days

- Signed informed consent form approved by the institutional review board (IRB) is
required

- DONOR: Any sibling donors who are histocompatible with the prospective recipient will
be considered a suitable donor

- DONOR: Donors will be excluded if for psychological or medical reasons they are
unable to tolerate the procedure

- DONOR: Donor should be able to donate peripheral blood stem cells or bone marrow

Exclusion Criteria:

- Prior radiation therapy that would exclude the use of total-body irradiation

- Patients who have undergone bone marrow transplantation previously and who have
relapsed

- Patients with psychological or medical condition that patients physician deems
unacceptable to proceed to allogeneic bone marrow transplant

- Pregnancy

- Electrocardiogram (EKG) showing ischemic changes or abnormal rhythm and/or an
echocardiogram or MUGA scan showing abnormal wall motion or ejection fraction < 50%