Umbilical Cord Blood Transplantation in Treating Patients With Hematologic Cancer or Nonmalignant Hematologic Disease

DISEASE CHARACTERISTICS:

• One of the following diagnoses:

  • Acute myeloid leukemia (AML), with or without myelodysplastic syndromes

    • Not in first complete remission (CR)* with translocations t(8;21) and inv (16) unless failure of first-line induction therapy

    • Not in first CR* with translocations t(15;17) abnormality unless:

      • Failure of first-line induction therapy OR
      • Molecular evidence of persistent disease
    • Not in first CR with Down syndrome
    • Patients with third or greater medullary relapse or refractory disease (other than primary induction failures) receive busulfan/melphalan conditioning regimen NOTE: * CR defined by no greater than 5% blasts in marrow

  • Acute lymphocytic leukemia (ALL)

    • Not in first CR OR

    • High-risk ALL in first CR, with high risk defined as one of the following:

      • Hypoploidy (no greater than 44 chromosomes)
      • Pseudodiploidy with translocations or molecular evidence of t(9;22), 11q23, or t(8;14) (except B-cell ALL) with or without MLL gene arrangement

      • Elevated WBC at presentation

        • Age 6-12 months: greater than 100,000/mm^3
        • Age 10-17 years: greater than 200,000/mm^3
        • Age 18: greater than 20,000/mm^3
      • Failed to achieve CR after 4 weeks of induction therapy

    • Patients with B-ALL must not be in first CR, must meet at least one of the high-risk criteria specified above, or must not meet any of the following criteria:

      • Translocation t(8;14)
      • Blasts have surface immunoglobulins
      • CD10 positive
    • Patients with third or greater medullary relapse or refractory disease (other than primary induction failures) receive busulfan/melphalan conditioning regimen

  • Chronic myelogenous leukemia, meeting criteria for 1 of the following:

    • Accelerated phase
    • Chronic phase if 1 year from diagnosis without a matched unrelated bone marrow donor AND unresponsive to or unable to tolerate interferon

    • Blast crisis, defined as greater than 30% promyelocytes plus blasts in bone marrow

      • Patients receive busulfan/melphalan conditioning regimen

  • Acute undifferentiated leukemia (AUL), infant leukemia, or biphenotypic leukemia

    • Patients with third or greater medullary relapse or refractory disease (other than primary induction failures) receive busulfan/melphalan conditioning regimen

  • Juvenile myelomonocytic leukemia meeting the following criteria:

    • No Philadelphia chromosome
    • Bone marrow blasts less than 30%
    • Peripheral blood monocytes greater than 1,000/mm^3

    • At least 2 of the following:

      • Peripheral blood spontaneous growth and/or sargramostim (GM-CSF) hypersensitivity
      • Increased hemoglobin F for age
      • Clonal abnormalities (e.g., monosomy 7 or RAS mutations)
      • Peripheral blood with myeloid precursors
      • WBC greater than 10,000/mm^3

  • Myelodysplastic syndromes defined by the following:

    • Refractory anemia (RA)
    • RA with ringed sideroblasts
    • RA with excess blasts (RAEB)
    • RAEB in transformation
    • Chronic myelomonocytic leukemia
  • Paroxysmal nocturnal hemoglobinuria
  • Hodgkin's lymphoma or non-Hodgkin's lymphoma beyond first CR or primary induction failures AND chemosensitive (greater than 50% reduction in tumor mass size)

  • Inborn error of metabolism including, but not limited to, Hurler's syndrome, adrenoleukodystrophy (ALD), Maroteaux-Lamy syndrome, globoid cell leukodystrophy, metachromatic leukodystrophy, fucosidosis, or mannosidosis

    • For ALD patients over age 5, IQ must be at least 80
    • For all other patients over age 5, IQ must be at least 70
    • For all patients age 5 and under, developmental quotient or clinical neurodevelopmental examination should demonstrate potential for stabilization at a level of functioning where continuous life support (e.g., mechanical ventilation) would not be predicted to be required in the year after transplantation

  • Combined immune deficiencies including, but not limited to:

    • Severe combined immunodeficiency (SCID) requiring cytoreduction
    • Wiskott-Aldrich syndrome
    • Leukocyte adhesion defect
    • Chediak-Higashi disease
    • X-linked lymphoproliferative disease
    • Adenosine deaminase deficiency
    • Purine nucleoside phosphorylase deficiency
    • X-linked SCID
    • Common variable immune deficiency
    • Nezelof's syndrome
    • Cartilage hair hypoplasia
• No dyskeratosis congenita
• No ALL, AML, AUL, or biphenotypic leukemia in third or higher medullary relapse or refractory disease other than primary induction failure
• No primary myelofibrosis or myelofibrosis grade 3 or worse
• No active CNS leukemia involvement (CSF with WBC greater than 5/mm^3 and malignant cells on cytospin)
• No consenting 5/6 or 6/6 HLA-matched related donor available
• 3-6/6 HLA-matched unrelated umbilical cord blood donor available

PATIENT CHARACTERISTICS:

Age:

• See Disease Characteristics
• 18 and under

Performance status:

• Karnofsky 70-100%, if age 16 to 18
• Lansky 50-100%, if under age 16

Life expectancy:

• Not specified

Hematopoietic:

• See Disease Characteristics

Hepatic:

• Bilirubin less than 2.5 mg/dL
• SGOT less than 5 times upper limit of normal

Renal:

• Creatinine normal for age OR
• Creatinine clearance or glomerular filtration rate greater than 50% lower limit of normal for age

Cardiovascular:

• If symptomatic:

  • LVEF greater than 40% (or shortening fraction greater than 26%) and improves with exercise OR
  • Shortening fraction greater than 26%

Pulmonary:

• If symptomatic:

  • DLCO, FEV_1, and FEC greater than 45% predicted OR
  • Oxygen saturation greater than 85% on room air

Other:

• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception
• HIV negative
• No uncontrolled viral, bacterial, or fungal infection

PRIOR CONCURRENT THERAPY:

Biologic therapy:

• See Disease Characteristics
• At least 1 year since prior allogeneic stem cell transplantation (SCT) with cytoreductive preparative therapy
• At least 6 months since prior autologous SCT
• No concurrent thrombopoietic growth factors

Chemotherapy:

• See Disease Characteristics
• See Biologic therapy

Endocrine therapy:

• Not specified

Radiotherapy:

• Not specified

Surgery:

• Not specified