Donor Stem Cell Transplant in Treating Patients With Myeloid Cancer or Other Disease

Inclusion Criteria:

• Primary acute myeloid leukemia (AML)

  • First complete remission (CR) with high risk features as defined by: failure to achieve remission by day 21 after induction chemotherapy, or the presence of chromosomal abnormalities involving any of the following: -5/de (5q), -7/del(7q), inversion 3q, abnormalities of 11q23, 20q, 21q, del(9q), translocation 6;9, translocation 9;22, abnormalities of 17p, or complex karyotype with > or = 3 abnormalities. Complete remission is defined as < 5% blasts in the marrow.
  • Second CR or subsequent in remission
  • Refractory or relapsed disease with absolute peripheral blood blasts < 2000/mcL
• Secondary AML in remission or relapse

• Chronic myelogenous leukemia (CML) in accelerated or blast phase

  • Accelerated phase is defined by any one of the following:

    • Blasts 10% to 19% of peripheral blood white cells or bone marrow cells
    • Peripheral blood basophils at least 20%
    • Persistent thrombocytopenia (<100 x 10^9/L) unrelated to therapy, or persistent thrombocytosis (>1000 x 10^9/L) unresponsive to therapy
    • Increasing spleen size and increasing white blood cell (WBC) count unresponsive to therapy
    • Cytogenetic evidence of clonal evolution (i.e., the appearance of an additional genetic abnormality that was not present in the initial specimen at the time of diagnosis of chronic phase CML)
    • Resistance to tyrosine kinase inhibitors (imatinib or other) defined as no complete cytogenetic response even if the above criteria are not met.

  • Blast phase is defined by either of the following:

    • Blasts 20% or more of peripheral blood white cells or bone marrow cells
    • Extramedullary blast proliferation
    • Large foci or clusters of blasts in bone marrow biopsy
• Primary myelodysplastic syndrome (MDS) with an IPSS score >1
• Secondary MDS with any international prostate symptom score (IPSS)
• Age ≤60 years
• Co-Morbidity score 0-2
• At least 35 days following start of preceding leukemia induction therapy

Exclusion Criteria:

• Patients for whom a suitable HLA genotypically identical sibling or fully matched HLA-A, -B, -C, and -DRB1 unrelated donor is available.
• Patients greater than 60 years of age.
• Hypersensitivity to thymoglobulin.
• Symptomatic uncontrolled coronary artery disease or congestive heart failure.
• Hepatic disease with transaminases or bilirubin > 2 times upper limit of normal (ULN) except for isolated hyperbilirubinemia attributed to Gilbert's syndrome.
• Severe hypoxemia with room air - Partial Pressure of Oxygen in Arterial Blood - (PAO2) < 70, supplemental oxygen-dependence, or carbon monoxide diffusing capacity (DLCO) < 50% predicted.
• Impaired renal function with creatinine > 2 times upper limit of normal (ULN) or creatinine clearance measured by 24-hour urine collection < 50% normal for age, gender, and weight.
• Patients with central nervous system (CNS) involvement with disease refractory to intrathecal chemotherapy.
• Patients who are human immunodeficiency virus (HIV) seropositive.
• Patients who are pregnant or breast-feeding.
• Patients with active infections that are untreated, or failing to respond to appropriate therapy.
• Karnofsky performance status < 50%.
• Prior allogeneic or autologous bone marrow, peripheral blood stem cell, or umbilical cord blood transplant.
• Inability to provide informed consent.
• Co-morbidity score >2
• Less than 35 days from start of previous leukemia induction therapy