Bone Marrow Transplant Plus Cyclophosphamide and Total-Body Irradiation in Treating Patients With Hematologic Cancer

DISEASE CHARACTERISTICS:

• One of the following hematologic malignancies/disorders:

  • Acute lymphoblastic leukemia

    • In second or subsequent complete remission (CR)
    • In first CR with high-risk features (e.g., Philadelphia chromosome-positive)
    • In first relapse and failed conventional salvage therapy

  • Acute myelogenous leukemia (AML)

    • In second or subsequent CR
    • In early first relapse
    • In full first relapse and failed conventional salvage therapy

    • In first CR with high-risk features, e.g., trisomy 8 or FAB 6/7

      • Standard-risk AML offered conventional-dose consolidation chemotherapy or autologous bone marrow transplantation

  • Chronic myelogenous leukemia in chronic, accelerated, or second chronic phase

    • No blast crisis
  • Severe aplastic anemia that has failed at least 1 course of immunosuppressive therapy
  • Paroxysmal nocturnal hemoglobinuria with high-risk features (e.g., disseminated intravascular coagulation, thrombotic events)

  • Myelodysplastic syndrome, i.e.:

    • Symptomatic, transfusion-dependent refractory anemia with excess blasts
    • (RAEB) or RAEB in transformation
  • Secondary leukemia in CR following conventional-dose induction chemotherapy
• Unrelated marrow donor available who is 8 out of 10-, 9 out of 10-, or 10 out of 10-antigen serologically HLA-matched at A, B, C, DRb, and DQB loci by molecular typing
• No CNS malignancy

PATIENT CHARACTERISTICS:

Age:

• 17 to 60

Performance status:

• Karnofsky 70-100%

Life expectancy:

• No reduction due to other serious illness

Hematopoietic:

• Not specified

Hepatic:

• Bilirubin less than 3 mg/dL
• AST/ALT no greater than twice normal

Renal:

• Creatinine no greater than 2.0 mg/dL
• Creatinine clearance greater than 60 mL/min

Cardiovascular:

• Left ventricular ejection fraction at least 45%
• No severe hypertension

Pulmonary:

• DLCO, FEV_1, and FVC at least 50%

Other:

• HIV negative
• No active infection at time of transplant
• No advanced diabetes
• No significant neurologic deficit
• No active drug or substance abuse
• No emotional disorders
• Able to participate in frequent medical care for at least 1-2 years
• Willing to comply with National Marrow Donor Program policies

PRIOR CONCURRENT THERAPY:

Biologic therapy

• See Disease Characteristics

Chemotherapy

• See Disease Characteristics

Endocrine therapy

• Not specified

Radiotherapy

• Not specified

Surgery

• Not specified