Total-Body Irradiation and Chemotherapy Followed By Donor Bone Marrow Transplant in Treating Young Patients With Hematologic Cancer

Inclusion Criteria

• •DISEASE CHARACTERISTICS:
• •One of the following diagnoses:
• •* Histologically confirmed good-risk acute myeloid leukemia (AML) in first remission with an HLA-compatible related donor
• •* Ineligible for unrelated bone marrow transplantation unless failed first-line induction chemotherapy or have molecular evidence of disease at time of transplantation
• •* Histologically confirmed high-risk AML in first remission
• •* High risk defined by cytogenetics, biphenotypic and undifferentiated leukemia phenotype, secondary AML, or AML after myelodysplastic syndromes (MDS)
• •* Eligible for related or unrelated donor transplantation
• •* Histologically confirmed acute lymphoblastic leukemia (ALL) or lymphoblastic lymphoma (LL) in first remission with high risk for relapse or in second or third remission
• •* High risk for relapse defined by hypodiploidy, pseudodiploidy with translocations t(9;22) or infant t(4;11), or failure to achieve remission after four weeks of induction therapy
• •* Eligible for related or unrelated donor transplantation
• •* Histologically confirmed chronic myelogenous leukemia (CML) in at least first chronic phase or acceleration with an HLA-compatible related donor
• •* Histologically confirmed CML in first chronic phase if failed conventional therapy or in at least second chronic phase or acceleration with an HLA-compatible unrelated donor
• •* Histologically confirmed non-Hodgkin's lymphoma beyond first complete remission or primary induction failure and tumors that are chemosensitive defined as at least 50% reduction in mass size
• •* Eligible for related or unrelated donor transplantation
• •* Histologically confirmed MDS with intermediate or high-risk disease defined by International Prognostic Scoring System and paroxysmal nocturnal hematuria
• •* Eligible for related or unrelated donor transplantation
• •Treatment-related MDS or leukemia allowed if primary malignancy (e.g., neuroblastoma or Ewing's sarcoma) at low risk of recurrence
• •No AML, ALL, or LL in relapse or greater than third remission
• •No CML in blast crisis defined as more than 30% blasts plus promyelocytes
• •No active CNS involvement
• •History of leukemia cutis allowed
• •HLA compatible donor available
• •* 5/6 or 6/6 HLA antigen matched related or unrelated
• •PATIENT CHARACTERISTICS:
• •Age:
• •18 and under
• •Performance status:
• •Karnofsky 70-100% OR
• •Lansky 50-100%
• •Life expectancy:
• •Not specified
• •Hematopoietic:
• •See Disease Characteristics
• •Hepatic:
• •Bilirubin no greater than 2.5 times upper limit of normal (ULN)
• •AST no greater than 3 times ULN (unless liver involvement is present)
• •Renal:
• •Creatinine normal OR
• •Creatinine clearance greater than 60 mL/min
• •Cardiovascular:
• •LVEF at least 50% at rest (if less than 50% at rest, must increase with exercise)
• •Pulmonary:
• •Asymptomatic with no prior risk features OR
• •DLCO greater than 40% predicted (corrected for hemoglobin) if symptomatic
• •Other:
• •Not pregnant or nursing
• •Negative pregnancy test
• •Fertile patients must use effective contraception
• •HIV I/II negative
• •No uncontrolled viral, bacterial, or fungal infection
• •No known hypersensitivity to bovine proteins
• •PRIOR CONCURRENT THERAPY:
• •Biologic therapy:
• •See Disease Characterisitics
• •Chemotherapy:
• •See Disease Characteristics
• •Endocrine therapy:
• •Not specified
• •Radiotherapy:
• •No prior radiotherapy that would preclude total body irradiation dose
• •Surgery:
• •Not specified