Allogenic Stem Cell Transplantation in Patients With High Risk CD33+ AML/MDS/JMML

Eligibility

Inclusion Criteria:

Disease Status

* AML Induction Failure
* AML in 1st, 2nd, or 3rd Relapse (\>10% bone marrow blasts)
* AML greater than or equal to 3rd CR
* MDS with \>6% bone marrow blasts at diagnosis
* Secondary MDS with less than or equal to 5% bone marrow myeloblasts at diagnosis
* JMML with \>6% bone marrow myeloblasts at diagnosis

Disease Immunophenotype Patients (AML only) receiving gemtuzumab ozogamicin must express minimum of \>10% or =10% CD33 positivity. Patients with \<10% CD33 positivity will not receive gemtuzumab ozogamicin.

Organ Function

Patients must have adequate organ function as defined below:

* Adequate renal function defined as:
* Serum creatinine \<1.5 x normal, or
* Creatinine clearance or radioisotope GFR 40 ml/min/m2 or \>60 ml/min/1.73 m2 or an equivalent GFR as determined by the institutional normal range
* Adequate liver function defined as:
* Total bilirubin 1.5 x normal, or SGOT (AST) or SGPT (ALT) \<2.0 x normal or =2.0 x normal
* Adequate cardiac function defined as:
* Shortening fraction of \>27% by echocardiogram, or
* Ejection fraction of \>47% by radionuclide angiogram or echocardiogram
* Adequate pulmonary function defined as:
* DLCO \>55% or =55% by PFT
* For children who are uncooperative, no evidence of dyspnea at rest, no exercise intolerance, and a pulse oximetry \>94% on room air

Exclusion Criteria:

* Patients with active CNS AML/JMML/MDS disease at time of conditioning therapy
* Female patients who are pregnant (positive HCG)
* Karnofsky \<50% or Lansky \<50% if 10 years or less
* Age \>65 years
* Has received gemtuzumab in the previous 30 days or has not recovered from prior gemtuzumab therapy.