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