T-Cell-Depleted Allogeneic Stem Cell Transplantation After Immunoablative Induction Chemotherapy and Reduced-Intensity Transplantation Conditioning in Treating Patients With Hematologic Malignancies

DISEASE CHARACTERISTICS:

• Diagnosis of 1 of the following hematologic malignancies:

  • Acute myeloid leukemia (AML), meeting 1 of the following criteria:

    • In first complete remission (CR1), meeting 1 of the following criteria:

      • Adverse cytogenetics with minimal residual disease detectable by flow cytometry, cytogenetic analysis, fluorescence in situ hybridization (FISH), or polymerase chain reaction (PCR), defined as 1 of the following:

        • Complex karyotype [≥ 3 abnormalities]
        • inv(3) or t(3;3)
        • t(6;9)
        • t(6;11)
        • Monosomy 7
        • Trisomy 8, alone or with an abnormality other than t(8;21), t(9;11), inv(16), or t(16;16)
        • t(11;19) (q23;p13.1)
      • Failed to achieve CR after primary induction chemotherapy
      • Secondary AML
    • In second or subsequent remission (CR2 or greater)

  • Acute lymphoblastic leukemia, meeting 1 of the following criteria:

    • In CR1, meeting 1 of the following criteria:

      • Adverse cytogenetics with minimal residual disease detectable by flow cytometry, cytogenetic analysis, FISH, or PCR, defined as the following:

        • Translocations involving 11q23, t(9;22), or bcr-abl rearrangement
      • Failed to achieve CR after primary induction chemotherapy
    • In CR2, if CR1 was < 12 months
    • In CR3 or greater

  • Myelodysplastic syndromes (MDS)

    • INT-2 or high-risk by International Prognostic Scoring System
    • No MDS with Fanconi anemia

  • Chronic myelogenous leukemia (CML), meeting 1 of the following criteria:

    • Accelerated phase with treatment failure after imatinib mesylate
    • Blast phase

  • Myeloproliferative disorders, meeting 1 of the following criteria:

    • Agnogenic myeloid metaplasia with adverse-risk features, meeting at least 2 of the following criteria:

      • Hemoglobin < 10 g/dL or > 10g/dL if transfusion-dependent
      • WBC < 4,000/mm^3 OR > 30,000/mm^3 OR requires cytoreductive therapy to maintain WBC < 30,000/mm^3
      • Abnormal cytogenetics, including +8, 12p-
    • Polycythemia vera or essential thrombocythemia in transformation to secondary AML

  • Myelodysplastic/myeloproliferative disease

    • Chronic myelomonocytic leukemia

  • Hodgkin's lymphoma or non-Hodgkin's lymphoma

    • Refractory lymphoma with progressive disease during combination chemotherapy
    • Relapse after OR ineligible for autologous stem cell transplantation (SCT)

  • Chronic lymphocytic leukemia

    • Treatment failure* after fludarabine, chlorambucil, and at least 1 other salvage regimen

  • Prolymphocytic leukemia (PLL), meeting 1 of the following criteria:

    • T-PLL

      • Treatment failure* after alemtuzumab and at least 1 other regimen

    • B-PLL

      • Treatment failure* after fludarabine and at least 1 other salvage regimen

  • Multiple myeloma, meeting 1 of the following criteria:

    • Relapse after autologous SCT
    • Plasma cell leukemia

    • Adverse cytogenetics, defined as 1 of the following:

      • del(13q) = 11q translocation NOTE: *Treatment failure is defined as relapse within 6 months OR failure to achieve remission

• Less than 10% blasts in bone marrow and no circulating blasts in peripheral blood for the following diagnoses:

  • Primary or secondary leukemia
  • Refractory anemia with excess blasts
  • CML
  • Other eligible diagnosis in transformation to acute leukemia
• Expected survival of approximately 1 year or less with conventional therapy

• No active CNS involvement by malignancy*

  • Prior CNS involvement with no current evidence of CNS malignancy allowed NOTE: *Active CNS malignancy is defined by lymphoma: tumor mass on CT scan or leptomeningeal disease OR leukemia: blasts present on cerebrospinal fluid cytospin

• Availability of a donor who is a sibling, parent, or offspring who shares 1 full haplotype (HLA-A, -B, or -DR)

  • Recipient and donor must have at least a 2-antigen disparity in either the host-versus-graft or graft-versus-host direction
  • Parent or offspring donor who is mismatched for a single HLA antigen (i.e., 5/6 HLA) is allowed
  • No sibling donor who is 6/6 HLA-matched OR mismatched for a single HLA antigen (i.e., 5/6 HLA)
  • No unrelated donor identified in a prior or current National Marrow Donor Program registry search

PATIENT CHARACTERISTICS:

Age

• 18 to 55

Performance status

• ECOG 0-2 OR
• Karnofsky 60-100%

Life expectancy

• At least 3 months

Hematopoietic

• See Disease Characteristics
• Absolute neutrophil count ≥ 1,000/mm^3*
• Platelet count ≥ 20,0000/mm^3* (without transfusion) NOTE: *Lower values may be accepted at the discretion of the principal investigator or study chairperson if due to bone marrow involvement by malignancy

Hepatic

• ALT and AST ≤ 2.5 times upper limit of normal (ULN)*
• Bilirubin ≤ 2.5 times ULN*
• Unconjugated hyperbilirubinemia consistent with Gilbert's syndrome allowed

• No chronic active hepatitis B infection

  • Hepatitis B core antibody positive allowed provided patient is surface antigen negative and has no evidence of active infection

• No hepatitis C viral infection

  • Seronegative for anti-hepatitis C antibody and detectable hepatitis C viral RNA by reverse transcriptase-polymerase chain reaction assay NOTE: *Higher levels may be accepted at the discretion of the principle investigator or study chairperson if such elevations are due to liver involvement by malignancy

Renal

• Creatinine ≤ 1.5 mg/dL OR
• Creatinine clearance ≥ 50 mL/min

Cardiovascular

• LVEF ≥ 45%

Pulmonary

• DLCO ≥ 50% of expected value (corrected for blood hemoglobin level and alveolar volume)

Other

• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception during and for 1 year after study participation
• HIV negative
• No active infection not responding to antimicrobial therapy
• No psychiatric disorder that would preclude study compliance or informed consent

PRIOR CONCURRENT THERAPY:

Biologic therapy

• See Disease Characteristics
• At least 2 weeks since prior monoclonal antibody therapy

Chemotherapy

• See Disease Characteristics
• At least 2 weeks since prior systemic chemotherapy

Endocrine therapy

• Not specified

Radiotherapy

• Not specified

Surgery

• Not specified

Other

• Recovered from all prior therapy
• No administration of tyrosine kinase (TK) inhibitors, including imatinib mesylate and dasatinib, during the conditioning regimen; TK inhibitor administration may resume 28 days after transplantation