Donor Umbilical Cord Blood Transplant in Treating Patients With Advanced Hematological Cancer or Other Disease

DISEASE CHARACTERISTICS:

• Diagnosis of advanced hematologic malignancy or other disease not curable by conventional chemotherapy, including any of the following:
• Acute myeloid leukemia in complete remission (CR)* (as defined by hematologic recovery, < 5% blasts in the bone marrow by morphology, and a cellularity of > 15%), meeting one of the following criteria:
• In first complete remission (CR1) AND has high-risk disease as evidenced by any of the following:
• Preceding myelodysplastic syndromes (MDS)
• High-risk cytogenetics (e.g., monosomy 5 or 7, or as defined by referring institution treatment protocol)
• Required > 2 courses of therapy to obtain CR
• Erythroblastic or megakaryocytic leukemia
• In second CR (CR2) or beyond
• Acute lymphoblastic leukemia in CR* (as defined by hematologic recovery, < 5% blasts in the bone marrow by morphology, and a cellularity of > 15%), meeting one of the following criteria:
• In CR1 AND has high-risk disease as evidenced by any of the following:
• t(9;22), t(1;19), t(4;11), or other MLL rearrangements
• Hyplodiploid
• Required > 1 course of therapy to obtain CR
• Beyond CR2
• Chronic myelogenous leukemia (CML)
• All types are allowed (except refractory blast crisis CML)
• Patients in chronic phase CML must have failed or been intolerant to prior imatinib mesylate (Gleevec) or other tyrosine kinase inhibitors
• MDS
• Any subtype allowed (including refractory anemia [RA])
• Severe pancytopenia or complex cytogenetics
• Blasts must be < 5% (if blasts are ≥ 5%, pre-transplant induction therapy is required to reduce blast count to < 5%)
• Large cell lymphoma, Hodgkin lymphoma, or multiple myeloma, meeting one of the following criteria:
• Chemotherapy-sensitive disease that has failed prior therapy
• Patients with large cell lymphoma or Hodgkin lymphoma must not have progressive disease during salvage therapy (stable disease allowed provided it is non-bulky)
• Ineligible for an autologous stem cell transplant
• Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), marginal zone B-cell lymphoma, or follicular lymphoma that has progressed after ≥ 2 prior therapies
• Patients with bulky disease should be considered for debulking chemotherapy prior to transplant
• Patients with refractory disease are eligible provided disease is non-bulky AND an estimated tumor doubling time is ≥ 1 month
• Lymphoplasmacytic lymphoma, mantle cell lymphoma, or prolymphocytic leukemia
• Chemotherapy-sensitive disease that was previously treated with initial therapy
• Patients with mantle cell lymphoma must not have progressive disease during salvage therapy (stable disease allowed provided it is non-bulky)
• Mycosis fungoides and Sezary syndrome
• Bone marrow failure syndromes, except for Fanconi anemia
• Myeloproliferative syndromes NOTE: *Patients for whom adequate marrow/biopsy specimens can not be obtained to determine remission status by morphologic assessment must have fulfilled criteria of remission (< 5% blasts by flow cytometry and recovery of peripheral blood counts with no circulating blasts)
• Ineligible for autologous stem cell transplant due to any of the following:
• Prior autologous stem cell transplant
• Inadequate autologous stem cell harvest
• Inability to withstand a myeloablative preparative regimen
• Clinically aggressive/high-risk disease
• No evidence of progressive disease by imaging modalities or biopsy (persistent PET scan activity allowed provided there are no CT scan changes indicating progression)
• Acute leukemia that is refractory, persistent, or relapsed (defined as > 5% blasts in normocellular bone marrow) allowed provided patient was rendered aplastic either by induction chemotherapy or radioimmunoconjugated monoclonal antibody therapy
• Patients with stable disease are eligible provided the largest residual nodal mass is approximately < 5 cm (largest residual mass must represent a 50% reduction and be approximately < 7.5 cm for patients who have responded to prior therapy)
• No active CNS malignancy
• Umbilical cord blood (UCB) donor available
• UCB graft matched at 4/6 HLA-A, -B, and -DRB1 antigens with the recipient
• May include 0-2 antigen mismatches at the A, B, or DRB1 loci
• Unit selection based on cryopreserved nucleated cell dose and HLA-A, -B, and -DRB1 using intermediate resolution A, B antigen and DRB1 allele typing
• If 2 UCB units are required to reach the target cell dose, each unit must be a 3/6 HLA-A, -B, and -DRB1 antigen match to each other, as well as a 4/6 antigen match to the recipient
• No 5-6/6 HLA-A, -B, and -DRB1 matched sibling donor available

PATIENT CHARACTERISTICS:

• Karnofsky performance status (PS) 60-100% OR Lansky PS 50-100%
• Creatinine ≤ 2.0 mg/dL (adults) OR creatinine clearance > 40 mL/min (pediatrics)
• Adult patients with a creatinine > 1.2 mg/dL or a history of renal dysfunction must have an estimated creatinine clearance of > 40 mL/min
• Not pregnant or nursing
• Negative pregnancy test
• LVEF ≥ 35%
• DLCO > 30% predicted
• No requirement for O_2
• No decompensated congestive heart failure
• No uncontrolled arrhythmia
• None of the following liver diseases or conditions:
• Fulminant liver failure
• Cirrhosis with evidence of portal hypertension or bridging fibrosis
• Alcoholic hepatitis
• Esophageal varices
• History of bleeding esophageal varices, hepatic encephalopathy, or correctable hepatic synthetic dysfunction as evidenced by prolongation of the prothrombin time
• Ascites related to portal hypertension
• Bacterial or fungal abscess
• Biliary obstruction
• Chronic viral hepatitis with total serum bilirubin > 3 mg/dL
• Symptomatic biliary disease
• Recent mold infection (e.g., Aspergillus) allowed provided patient received ≥ 30 days of appropriate treatment AND infection is controlled and cleared by Infectious Disease
• No evidence of HIV infection or known HIV-positive serology
• No uncontrolled viral or bacterial infection

PRIOR CONCURRENT THERAPY:

• See Disease Characteristics
• At least 3 months since prior myeloablative stem cell transplantation