Donor Bone Marrow Transplant in Treating Patients With Leukemia, Lymphoma, or Nonmalignant Hematologic Disorders

DISEASE CHARACTERISTICS:

• Histologically confirmed diagnosis of one of the following:

  • Acute lymphocytic leukemia (ALL):

    • Complete remission (CR) 1 - high risk defined as overt CNS involvement or poor cytogenetics (additions, deletions, translocations, or multiple abnormalities)
    • CR2
    • Induction failures
    • Relapse - patients with at least 10% marrow blasts undergo at least one reinduction attempt

  • Acute myelogenous leukemia (AML):

    • CR1 - high risk defined as poor cytogenetics (deletions, additions, multiple abnormalities)
    • CR2
    • Induction failures
    • Relapse - patients with at least 10% marrow blasts undergo at least one reinduction attempt

  • Chronic myelogenous leukemia (CML):

    • Chronic phase (CP) 1
    • Accelerated phase/CP2 - patients in blast phase must undergo treatment and achieve a second chronic phase prior to transplant

  • Chronic lymphocytic leukemia (CLL):

    • Relapse - any stage; must have received no more than 3 prior regimens

  • Multiple myeloma:

    • At diagnosis - primary refractory
    • Relapse (no more than 2) - sensitive disease
    • Plasma cell leukemia
    • Inability to achieve a complete remission after autologous transplant (no older than 40)
  • Myelodysplasia - all subtypes
  • Myeloproliferative disorders - patients with poor response to medical therapy or cytogenetic abnormalities

  • Severe aplastic anemia (SAA):

    • Very SAA - at diagnosis
    • SAA - induction therapy
• Donors must be a phenotypic (6 out of 6) match or a one antigen (A or B) mismatch

PATIENT CHARACTERISTICS:

Age:

• 15 to 50

Performance status:

• Karnofsky 80-100%

Life expectancy:

• Not specified

Hematopoietic:

• See Disease Characteristics

Hepatic:

• Bilirubin no greater than 2.0 mg/dL
• SGOT and SGPT no greater than 3 times normal
• PT/PTT normal

Renal:

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

Cardiovascular:

• Left ventricular ejection fraction at least 45%
• No myocardial infarction within past 6 months
• No uncontrolled arrhythmias

Pulmonary:

• FEV1 at least 50%
• DLCO at least 50% predicted

Other:

• No active serious infection
• HIV negative
• Not pregnant or nursing
• No uncontrolled diabetes mellitus or thyroid disease

PRIOR CONCURRENT THERAPY:

Biologic therapy:

• See Disease Characteristics

Chemotherapy:

• See Disease Characteristics

Endocrine therapy:

• Not specified

Radiotherapy:

• Not specified

Surgery:

• Not specified