Reduced-Intensity Busulfan and Fludarabine With or Without Antithymocyte Globulin Followed by Donor Stem Cell Transplant in Treating Patients With Hematologic Cancer or Other Disease (LCCC 0306)

DISEASE CHARACTERISTICS:

• Histologically confirmed diagnosis of 1 of the following:

  • Chronic lymphocytic leukemia (CLL), meeting the following criteria:

    • Absolute lymphocyte count > 5,000/mm³
    • Lymphocytes must appear morphologically mature with < 55% prolymphocytes
    • Lymphocyte phenotype with expression of CD19 and CD5

  • Prolymphocytic leukemia (PLL), meeting the following criteria:

    • Absolute lymphocyte count > 5,000/mm³
    • More than 55% prolymphocytes
    • Morphologically diagnosed

  • Chronic myelogenous leukemia (CML), meeting the following criteria:

    • Diagnosis of CML or similar myeloproliferative disorders based on t(9;22) or related t(9;12) cytogenetic abnormalities AND characterized by elevated WBC counts in peripheral blood or bone marrow
    • In first chronic phase CML and a candidate for treatment with reduced-dose busulfan
    • Patients with other cytogenetic abnormalities, such as t(9;12), that are associated with an aggressive clinical course are eligible

  • Non-Hodgkin's lymphoma (NHL), meeting the following criteria:

    • Any WHO class histologic subtype allowed
    • Core biopsies are acceptable provided they contain adequate tissue for primary diagnosis and immunophenotyping
    • Bone marrow biopsies as sole means of diagnosis are not allowed for follicular lymphoma

  • Hodgkin's lymphoma, meeting the following criteria:

    • Any WHO class histologic subtype allowed
    • Core biopsies are acceptable provided they contain adequate tissue for primary diagnosis and immunophenotyping

  • Multiple myeloma, meeting the following criteria:

    • Active disease requiring treatment (Durie-Salmon stages I, II, or III)
  • Acute myeloid leukemia with documented control, defined as < 10% bone marrow blasts and no circulating blasts

  • Acute lymphoblastic leukemia, meeting the following criteria:

    • In early first relapse or beyond OR in first complete remission and has 1 of the following high-risk features:

      • t(9;22) or t(4;11)
      • WBC count > 30,000/mm³ at presentation
      • Non-T-cell phenotype
      • More than 30 years of age

  • Agnogenic myeloid metaplasia/myelofibrosis

    • Patients who are transfusion dependent or who have evolving myelodysplastic or leukemic features or high-risk cytogenetic abnormalities are eligible
  • Myelodysplastic syndromes (MDS) as defined by WHO criteria

• Meets 1 of the following criteria:

  • Over 55 years of age
  • Ineligible for busulfan-based therapy based on diminished organ function or poor performance status
  • Indolent and chemotherapy-responsive CLL, low-grade NHL, small lymphocytic lymphoma, or PLL
• Patients who have undergone prior autologous stem cell transplantation are preferentially enrolled on clinical trial CALGB-100002, if available and patient is eligible

• HLA-matched or mismatched related donor or HLA-matched unrelated donor available

  • HLA-identical sibling (6/6 or 9/10) (minimal serologic typing required for class I [A, B]; molecular typing required for class II [DRB1])
  • 9/10 matched unrelated donor (MUD) (molecular analysis at HLA A, B, C, DRB1, and DQB1 by high resolution typing required)
  • 5/6 MUD (molecular analysis at HLA A, B, and DRB1 required)
  • No syngeneic donors

PATIENT CHARACTERISTICS:

• Creatinine clearance ≥ 40 mL/min
• Bilirubin ≤ 3 times upper limit of normal (ULN)
• AST ≤ 3 times ULN
• DLCO > 40% with no symptomatic pulmonary disease
• LVEF ≥ 30% by MUGA
• No uncontrolled diabetes mellitus or active serious infection
• No known hypersensitivity to Escherichia coli-derived products
• No HIV infection
• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception

PRIOR CONCURRENT THERAPY:

• See Disease Characteristics
• More than 4 weeks since prior chemotherapy, radiotherapy (except prophylactic cranial x-ray therapy), or surgery