Donor Umbilical Cord Blood Transplantation in Treating Patients With Leukemia, Lymphoma, or Nonmalignant Hematologic Disorders

DISEASE CHARACTERISTICS:

• Diagnosis of 1 of the following hematologic malignancies:
• Acute myeloid leukemia (AML)*
• With or without history of myelodysplastic syndromes (MDS)
• Patients in first complete remission (CR) (no greater than 5% blasts in marrow) with translocations t(8;21) and inv(16) are allowed provided they failed first-line induction therapy
• Patients in first CR (no greater than 5% blasts in marrow) with translocations t(15;17) are allowed provided at least 1 of the following is true:
• Failed first-line induction therapy
• Molecular evidence of persistent disease
• No patients in first CR and with Down syndrome
• Acute lymphoblastic leukemia (ALL)*, meeting 1 of the following criteria:
• Not in first CR (no greater than 5% blasts in marrow)
• In first CR and high risk as defined by 1 of the following:
• Hypoploidy (no more than 44 chromosomes)
• Pseudodiploidy with translocations or molecular evidence of t(9;22), 11q23, or t(8;14) (excluding B-ALL) or +MLL gene rearrangement
• One of the following elevated WBC levels:
• WBC greater than 100,000/mm^3 if 6 to 12 months of age
• WBC greater than 200,000/mm^3 if between 10 and 17 years of age
• WBC greater than 20,000/mm^3 if 18 years of age and over (adult [over 18 years of age] patient stratum closed to accrual)
• Failed to achieve CR after 4 weeks of induction therapy
• B-ALL that is not in first CR or that meets at least 1 of the high-risk criteria specified above
• No translocation t(8;14)
• No blasts with surface immunoglobulins
• CD10 negative
• Undifferentiated leukemia*
• Infant leukemia*
• Biphenotypic leukemia*
• Chronic myelogenous leukemia, meeting 1 of the following criteria:
• Accelerated phase
• Chronic phase
• At least 1 year from diagnosis without an identified matched unrelated bone marrow donor AND unresponsive to or unable to tolerate interferon
• Blast crisis* (greater than 30% promyelocytes plus blasts in the marrow)
• One of the following MDS:
• Refractory anemia
• Refractory anemia with ringed sideroblasts
• Refractory anemia with excess blasts (RAEB)
• RAEB in transformation
• Chronic myelomonocytic leukemia
• Paroxysmal nocturnal hemoglobinuria
• Hodgkin's or non-Hodgkin's lymphoma beyond first CR or failed primary induction therapy
• Tumor displays chemosensitivity (greater than 50% reduction in mass size after the most recent therapy) NOTE: *Patients in third or greater medullary relapse or refractory disease (other than primary induction failures) or blast crisis receive the study busulfan/melphalan conditioning regimen)

OR

• Diagnosis of one of the following nonmalignant diseases :
• Acquired severe aplastic anemia (stratum closed to accrual)
• Unresponsive to medical therapy with anti-thymocyte globulin and/or cyclosporine
• Inborn errors of metabolism, including, but not limited to the following:
• Hurler's syndrome
• Adrenoleukodystrophy
• Maroteaux-Lamy syndrome
• Globoid cell leukodystrophy
• Metachromatic leukodystrophy
• Fucosidosis
• Mannosidosis
• Fanconi anemia documented by increased chromosomal fragility assays and meeting 1 of the following criteria (stratum closed to accrual):
• Severe pancytopenia
• Absolute neutrophil count less than 500/mm^3
• Platelet count less than 20,000/mm^3
• Hemoglobin less than 8 g/dL
• Morphologic evidence of MDS with clonal chromosomal abnormalities
• Leukemia transformation
• Other marrow failure syndromes, including any of the following (stratum closed to accrual):
• Blackfan-Diamond syndrome that is unresponsive to medical therapy
• Kostmann's congenital agranulocytosis unresponsive to medical therapy
• Congenital amegakaryocytic thrombocytopenia
• Thrombocytopenia absent radius
• Combined immune deficiencies including, but not limited to the following:
• Severe combined immunodeficiency (SCID)
• Wiskott-Aldrich syndrome
• Leukocyte adhesion defect
• Chediak-Higashi disease
• X-linked lymphoproliferative disease
• Adenosine deaminase deficiency
• Purine nucleoside phosphorylase deficiency
• X-linked SCID
• Common variable immune deficiency
• Nezeloff's syndrome
• Cartilage hair hypoplasia
• Reticular dysgenesis
• No active CNS leukemia (cerebrospinal fluid with WBC greater than 5/mm^3 and malignant cells on cytospin)
• No SCID patients who do not require cytoreduction
• No dyskeratosis congenita
• No primary myelofibrosis
• No grade 3 or greater myelofibrosis
• Familial erythrophagocytic lymphohistiocytosis patients must not have any of the following:
• Abnormal brain MRI
• Neurologic symptoms
• Lymphocytes and monocytes greater than 7/mm^3 in the cerebrospinal fluid
• No available 5/6 or 6/6 HLA-matched related donor

PATIENT CHARACTERISTICS:

Age

• 55 and under (over 18 closed to accrual)

Performance status

• Karnofsky 70-100% OR
• Lansky 50-100% (patients under 16 years old)

Life expectancy

• Not specified

Hematopoietic

• See Disease Characteristics

Hepatic

• SGOT less than 5 times upper limit of normal
• Bilirubin less than 2.5 mg/dL

Renal

• Creatinine normal for age OR
• Creatinine clearance or glomerular filtration rate greater than 50% of lower limit of normal

Cardiovascular

• LVEF greater than 40% at rest and must improve with exercise* OR
• Shortening fraction greater than 26%* NOTE: *If symptomatic

Pulmonary

• DLCO greater than 45% of predicted* (corrected for hemoglobin)
• FEV_1 and FEC greater than 45% of predicted (corrected for hemoglobin) OR
• Room air oxygen saturation greater than 85%* NOTE: *If symptomatic

Other

• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception
• No uncontrolled viral, bacterial, or fungal infection
• HIV negative

PRIOR CONCURRENT THERAPY:

Biologic therapy

• See Disease Characteristics
• More than 12 months since prior allogeneic stem cell transplantation with cytoreductive preparative therapy
• More than 6 months since prior autologous stem cell transplantation

Chemotherapy

• See Biologic therapy

Endocrine therapy

• Not specified

Radiotherapy

• Not specified

Surgery

• Not specified

Other

• No prior enrollment on this study
• No continuous life support (e.g., mechanical ventilation) within 1 year after study transplantation (for patients with inborn errors of metabolism)