Donor Stem Cell Transplant After Busulfan, Fludarabine, Methylprednisolone, and Antithymocyte Globulin in Treating Patients With Bone Marrow Failure Syndrome

DISEASE CHARACTERISTICS:

• Diagnosis of any of the following bone marrow failure syndromes:

  • Severe aplastic anemia, meeting 1 of the following criteria:

    • Not responsive to immunosuppressive therapy
    • With recurrent cytopenia after immunosuppressive therapy or allogeneic hematopoietic cell transplantation

  • Low-risk myelodysplastic syndrome, including any of the following:

    • Refractory anemia
    • Refractory anemia with ringed sideroblasts
    • Refractory cytopenia with multi-lineage dysplasia

  • Paroxysmal nocturnal hemoglobinuria, meeting 1 of the following criteria:

    • With thrombotic episodes
    • With severe cytopenia

• No willing, suitable HLA-compatible donor in family or in donor registries

  • Related donor with HLA-haploidentical mismatch at three or less of 6 loci
  • Patients with very severe neutropenia (< 200/μL) or febrile episodes, who feel urgent need for allogeneic hematopoietic cell transplantation, are eligible without a search for HLA-matched unrelated donors

PATIENT CHARACTERISTICS:

• Karnofsky performance status 70-100%
• Bilirubin < 2.0 mg/dL
• AST < 3 times upper limit of normal
• Creatinine < 2.0 mg/dL
• Ejection fraction > 40% by MUGA scan

PRIOR CONCURRENT THERAPY:

• See Disease Characteristics