Fludarabine, Cyclophosphamide, and Total-Body Irradiation Followed by Cyclosporine and Mycophenolate Mofetil in Treating Patients Who Are Undergoing a Donor Umbilical Cord Blood Transplant for Hematologic Cancer

DISEASE CHARACTERISTICS:

• Diagnosis of 1 of the following hematologic malignancies:
• Acute myeloid leukemia (AML) with or without history of myelodysplastic syndromes, meeting 1 of the following criteria:
• In first complete remission (CR-1) with unfavorable cytogenetics and/or achieved CR-1 after ≥ 1 course of induction therapy
• Secondary or treatment-related AML
• In second or further complete remission
• Relapsed with ≤ 20% blasts in the bone marrow AND no circulating blasts
• Acute lymphoblastic leukemia (ALL), meeting 1 of the following criteria:
• In CR-1 with unfavorable cytogenetics or elevated WBC at presentation OR failed to achieve CR-1 after ≥ 4 weeks of induction therapy
• In second or further complete remission
• Relapsed with ≤ 20% blasts in the bone marrow AND no circulating blasts
• Other acute leukemic variants allowed at the discretion of the principal investigator
• Chronic myelogenous leukemia (CML), meeting 1 of the following criteria:
• In first chronic phase AND refractory to or unable to tolerate imatinib mesylate
• In second or further chronic phase
• In first or second accelerated phase
• Myelodysplastic syndromes with intermediate 2- or high-risk International Prognosis Scoring System (IPSS) score, including any of the following:
• Refractory anemia
• Refractory anemia with excess blasts
• Chronic myelomonocytic leukemia
• Myeloproliferative disorders with poor prognosis, including any of the following:
• Myelofibrosis with myeloid metaplasia
• No ≥ grade 3 myelofibrosis
• Atypical CML
• Juvenile myelomonocytic leukemia
• Other clonal hemopathies with an accepted poor prognosis
• Multiple myeloma with chromosome 13 abnormalities and/or progression after prior autologous bone marrow transplantation (BMT)
• Chronic lymphocytic leukemia, meeting 1 of the following criteria:
• Primary refractory OR relapsed and refractory disease (less than partial remission)
• Relapsed twice on or after prior chemotherapy
• Lymphoma, meeting both of the following criteria:
• Hodgkin's or non-Hodgkin's lymphoma in > CR-1 OR failed primary induction
• Chemosensitive disease, defined as > 50% reduction in mass size after the most recent chemotherapy
• Must meet ≥ 1 of the following criteria:
• Over 45 years of age
• Has undergone prior autologous or allogeneic BMT
• Charlson^ comorbidity score ≥ 2
• Must have a high degree of tumor control (salvage therapy allowed)
• At high risk for treatment-related mortality with a myeloablative conditioning regimen
• No massive splenomegaly
• Patients may become eligible after splenectomy or radiotherapy to the spleen
• No 5/6 or 6/6 HLA-matched related donor available
• No well-matched (i.e., ≥ 9/10 HLA match by high-resolution typing) unrelated donor available

PATIENT CHARACTERISTICS:

Performance status

• Not specified

Life expectancy

• Not specified

Hematopoietic

• See Disease Characteristics

Hepatic

• Bilirubin ≤ 2 times upper limit of normal (ULN)
• Transaminases ≤ 4 times ULN (unless due to underlying disease)

Renal

• Creatinine clearance ≥ 50 mL/min

Cardiovascular

• Ejection fraction ≥ 30%

Pulmonary

• DCLO ≥ 35%

Other

• Negative pregnancy test
• No uncontrolled viral, bacterial, or fungal infection
• HIV negative

PRIOR CONCURRENT THERAPY:

Biologic therapy

• See Disease Characteristics

Chemotherapy

• See Disease Characteristics

Radiotherapy

• See Disease Characteristics

Other

• At least 3 months since prior immunosuppressive therapy
• At least 10 days since prior salvage therapy for patients not in at least morphologic or radiologic complete remission