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)