Fludarabine Phosphate, Melphalan, and Low-Dose Total-Body Irradiation Followed by Donor Peripheral Blood Stem Cell Transplant in Treating Patients With Hematologic Malignancies

Exclusion Criteria

• •First remission lymphoblastic lymphoma, or small, non-cleaved cell lymphoma or mantle cell lymphoma
• •HODGKIN LYMPHOMA:
• •Received and failed front-line therapy
• •single antigen mismatch at HLA A, B, or DRB1; unrelated donors
• •a single antigen mismatch at HLA A, B, or C, +/- additional single allele level mismatch at A, B, V or DRB1
• •Minimum goal for peripheral blood stem cells (PBSC) dose is 2 x 10\^6 CD34+ cells/kg of recipient weight; minimum goal for the marrow dose is 1 x 10\^8 nucleated cells/kg of recipient weight
• •No serious uncontrolled psychiatric illness
• •No concomitant active malignancy that would be expected to require chemotherapy within 3 years of transplant (other than non-melanoma skin cancer)
• •Non-pregnant and non-nursing woman; (women or men with reproductive potential should agree to use an effective means of birth control)
• •Patients who have failed a prior autologous or allogeneic transplant are eligible; however, at least 90 days must have elapsed between the start of this reduced intensity conditioning regimen and the last transplant if patient had a prior autologous or myeloablative allogeneic bone marrow transplant (BMT)
• •At least 2 weeks since prior chemotherapy, radiation treatment and/or surgery
• •Informed consent
• •DONOR: Compatibility at the four most informative HLA loci:
• •A, B, C and DRB1 are important for reducing the risk of GVHD and successful transplant outcomes; the A, B, C and DRB1 loci comprise 8 possible alleles (a haplotype being inherited from each parent); one additional locus, HLA-DQ, is also typed to ascertain haplotypes and assist in the search for a compatible donor; however mismatching at DQ has not been shown to be associated with adverse outcomes; high resolution molecular typing (at the allele level) is now the standard of care for unrelated donor searches and allows greater refinement of the search strategy
• •DONOR: Matched related donor:
• •a single antigen mismatch at A, B, or the DR transplant from a family member is associated with a higher risk of GVHD but similar overall survival when compared to full identity at these 3 regions; related donor/recipient pairs must be matched at 5 of 6 HLA antigens (A, B, DRB1)
• •DONOR: Unrelated Donor:
• •Uncontrolled central nervous system (CNS) disease (for hematologic malignancies)
• •Karnofsky (adult) or Lansky (for =\< 16 years) performance status \< 50%
• •Diffusing capacity of the lung for carbon monoxide (DLCO) \< 40% predicted, corrected for hemoglobin and/or alveolar ventilation
• •Left ventricular ejection fraction \< 40% - Bilirubin \>= 3 X upper limit of normal
• •Liver alkaline phosphatase \>= 3 x upper limit of normal
• •Serum glutamic oxaloacetic transaminase (SGOT) or serum glutamic pyruvate transaminase (SGPT) \>= 3 x upper limit of normal
• •Child's class B and C liver failure
• •Calculated creatinine clearance \< 40 cc/min by the modified Cockroft-Gault formula for adults or the Schwartz formula for pediatrics
• •Patients who have received maximally allowed doses (given in 2 Gy fractionations, or equivalent) of previous radiation therapy to various organs as follows: \* Mediastinum: adult -40, pediatric (=\<18 yrs) - 21 \* Heart: adult 36, pediatric - 26 \* Whole lung(s): adult - 12, pediatric - 10 \* Small bowel: adult - 46, pediatric - 40 \* Kidneys: adult - 12, pediatric - 10 \* Whole liver: adult - 20, pediatric - 20 \* Spinal cord: adult - 36, pediatric - 36 \* Whole Brain: adult 30, pediatric - 30
• •Patients who previously have received a higher than allowed dose of radiation to a small lung, liver, and brain volume, will be evaluated by the radiation oncologist to determine if the patient is eligible for study
• •Uncontrolled diabetes mellitus, cardiovascular disease, active serious infection or other condition which, in the opinion of treating physician, would make this protocol unreasonably hazardous for the patient
• •Human immunodeficiency virus (HIV) positive
• •Patients who in the opinion of the treating physician are unlikely to comply with the restrictions of allogeneic stem cell transplantation based on formal psychosocial screening
• •Female of childbearing potential with a positive pregnancy test