Donor Stem Cell Transplant in Treating Patients With High-Risk Hematologic Cancer

* Diagnosis of one of the following hematological malignancies:

  * CML, with 1 of the following:

    * In first CP AND failed imatinib mesylate therapy, defined as failure to obtain a hematologic remission at 3 months or a major cytogenetic response (i.e., Ph+ cells \< 35%) at 6 months or demonstrated clonal evolution or disease progression during therapy
    * In accelerated phase with \< 15% blasts
    * In blast crisis that has entered into a second CP following induction chemotherapy
  * AML, with 1 of the following:

    * In second or subsequent complete remission (CR) (i.e., \< 5% blasts by morphology, no residual leukemia by flow cytometry, and absence of cytogenetic abnormalities)
    * Failed primary induction chemotherapy, but subsequently entered into a CR with ≤ 2 subsequent re-induction chemotherapy treatment(s)
    * In first CR with intermediate-risk or poor-risk cytogenetics
  * ALL with 1 of the following:

    * In second or subsequent CR
    * In first CR AND presence of t(9;22)
  * MDS, with the following:

    * High-risk disease, defined by IPSS score of ≥ 1.5 at diagnosis AND meets 1 of the following criteria:

      * ≤ 10% blasts at diagnosis
      * In morphologic CR (\< 5% blasts) following cytoreductive chemotherapy
  * CMML, with 1 of the following:

    * ≤ 10% blasts at diagnosis
    * In morphologic CR (\< 5% blasts) following cytoreductive chemotherapy
  * CLL/PLL with the following:

    * Rai stage I-IV disease
    * Failed ≥ 1 prior chemotherapy regimen (including fludarabine phosphate) or ASCT
    * Documented chemosensitive or stable, non-bulky disease prior to transplant, defined as \< 20% bone marrow involvement AND lymph node size \< 3 cm in axial diameter
    * No bulky tumor masses, elevated lactate dehydrogenase (LDH), B symptoms, or progressive disease prior to transplant
  * Low-grade non-Hodgkin lymphoma (NHL) (i.e., small lymphocytic lymphoma, follicular center lymphoma \[grade 1 or 2\], marginal zone lymphoma, or B-cell lymphoma), with the following criteria:

    * Failed ≥ 1 prior chemotherapy regimen or ASCT
    * Documented chemosensitive or stable, non-bulky disease prior to transplant, defined as \< 20% bone marrow involvement AND lymph node size \< 3 cm in axial diameter
    * Received ≤ 3 prior chemotherapy regimens (monoclonal antibody therapy and involved-field radiotherapy are not considered a prior regimen)
    * No bulky tumor masses, elevated LDH, B symptoms, or progressive disease prior to transplant
  * Mantle cell lymphoma, with the following:

    * Failed to achieve remission or recurred after either conventional chemotherapy or ASCT
    * Responsive or stable disease to most recent prior therapy
    * No bulky tumor masses, elevated LDH, B symptoms, or progressive disease prior to transplant
  * Intermediate-grade NHL (i.e., follicular center lymphoma \[grade 3\] or diffuse large cell lymphoma), meeting the following criteria:

    * Failed to achieve remission or recurred after either conventional chemotherapy or ASCT
    * Documented chemosensitive, non-bulky disease prior to transplant, defined as at least a partial remission to salvage chemotherapy (≥ 50% reduction in diameter of all disease sites)
    * No bulky tumor masses, elevated LDH, B symptoms, or progressive disease prior to transplant
  * Hodgkin lymphoma, with the following:

    * Relapsed after prior ASCT OR after ≥ 2 combination chemotherapy regimens and ineligible for ASCT
    * Documented chemosensitive, non-bulky disease prior to transplant, defined as at least a partial remission to salvage chemotherapy (≥ 50% reduction in diameter of all disease sites)
    * No bulky tumor masses, elevated LDH, B symptoms, or progressive disease prior to transplant
  * Peripheral T-cell NHL, with the following:

    * Failed to achieve remission or recurred after either conventional chemotherapy or ASCT
    * Documented chemosensitive, non-bulky disease prior to transplant, defined as at least a partial remission to salvage chemotherapy (≥ 50% reduction in diameter of all disease sites)
    * No bulky tumor masses, elevated LDH, B symptoms, or progressive disease prior to transplant
* Myeloproliferative syndrome with poor risk features, meeting 1 of the following criteria:

  * \< 55 years old AND Lille score of 1
  * Lille score of 2
  * HgB \< 10 g/dL AND abnormal karyotype
* High-risk disease, with 1 of the following:

  * Age 40-72 years
  * Any age AND deemed to be at significantly increased risk of morbidity and death following a standard, myeloablative unrelated donor stem cell transplant (e.g., received extensive prior therapy, including ASCT)
* HLA-matched unrelated donor available, with 1 of the following:

  * 8/8 match at HLA-A, B, C, or DR loci by high-resolution genotyping
  * Single allelic mismatch at either the HLA-B or HLA-C loci donor by high-resolution molecular typing

    * No single allelic mismatch at HLA-A or HLA-DR loci
* KPS 80-100%
* Adapted weighted Charlson Comorbidity Index \< 3
* Serum creatinine ≤ 2.0 mg/dL
* AST or ALT \< 3 times upper limit of normal (ULN)
* Total bilirubin \< 1.5 times ULN
* LVEF ≥ 45%
* DLCO \> 50%
* No hypoxia at rest with oxygen saturation \< 92% on room air (corrected with bronchodilator therapy)
* No other severe pulmonary function abnormalities
* No HIV infection
* No active hepatitis B or C infection that, in the opinion of a gastroenterologist or the transplant committee, places the patient at moderate to high risk for developing severe hepatic disease
* No active opportunistic infection (e.g., fungal pneumonia, tuberculosis, or viral infection)