High-Dose Busulfan and High-Dose Cyclophosphamide Followed By Donor Bone Marrow Transplant in Treating Patients With Leukemia, Myelodysplastic Syndrome, Multiple Myeloma, or Recurrent Hodgkin or Non-Hodgkin Lymphoma

This is an interventional treatment trial for Accelerated Phase Chronic Myelogenous Leukemia Read More

Criteria

• Acute non-lymphocytic leukemia (FAB types M1-M7) in first, or second remission, or early first or second bone or marrow relapse (>31% marrow blasts and no circulating peripheral blasts)
• All patients with acute promyelocytic leukemia in first complete remission who have received retinoic acid and chemotherapy are not eligible
• Acute lymphocytic leukemia in first or second remission, or early first or second bone marrow relapse (31% marrow blasts and no circulating peripheral blasts)
• Pediatric ALL patients in first complete remission are not eligible
• Chronic myelogenous leukemia in first or second chronic phase, or accelerated phase
• Myelodysplastic syndrome =< 50 years
• Lymphoma patients age =< 50 years (non Hodgkins or Hodgkins) in first or second relapse, or refractory disease, who are ineligible for autologous bone marrow transplantation because of tumor in the bone marrow
• Multiple myeloma patients age =< 50 who have relapsed or are refractory to at least 2 chemo-radiation or chemotherapy regimens
• Patients who have failed a previous allogeneic bone marrow transplant
• Patients with inborn errors of metabolism
• ECOG performance status of 0 or 1
• Karnofsky performance status of >= 70%
• Patients must be HTLV-III (HIV) anti-body negative
• Acute and chronic leukemia patients must be age =< 50 years; patients up to age 60 years for any of these diseases who have a syngeneic donor are eligible
• Patients (or bone marrow donors) who are HTLV-III (HIV) antibody positive are ineligible for this study
• Patients must not have active infection
• Patients must not have cytotoxic chemotherapeutic agents for at least 4 weeks before the transplant conditioning regimen is to begin
• It is recommended but not required that acute leukemia patients undergoing transplantation in first remission must have received at least one course of consolidation therapy
• Patients undergoing transplant in early relapse are eligible for transplant in first and second relapse only
• Patients must have no history of acute myocardial infarction in the 6 months prior to transplantation, angina pectoris requiring nitrate therapy, uncontrolled major ventricular dysrhythmia, uncontrolled hypertension, or uncontrolled congestive heart failure
• A gated-pool radionuclide scan fraction must be >= 50%
• Serum creatinine must be =< 1.8% and a 24 hour creatinine clearance must be >= 60ml/min
• Serum direct bilirubin >= 1.8mg%, or serum SGOT or SGPT > twice normal will exclude patients from this study
• Severe symptomatic CNS disease of any etiology other than CNS leukemia will exclude patients from study
• FEV1 and DLco (corrected) must be >= 60% of normal
• pO2 > 60mmHg
• Insulin-dependent diabetes mellitus or uncompensated major thyroid or adrenal dysfunction render patients ineligible
• Written informed consent must be obtained
• Patients treated previously with radiation therapy in excess of 1000 cGy (rads) to any thoracic or abdominal port, or in excess of 3000 cGy (rads) to cranial-spinal ports, who are not eligible for other protocols are eligible for this study
• DONOR: All genotypically HLA- or D/DR identical siblings are eligible to be bone marrow donors so long as their general medical condition permits the safe use of general or spinal anesthesia; selected donors who are not HLA-identical may be considered for use as long as they are D/DR identical, MLC compatible, and are in good condition to safely undergo spinal or general anesthesia
• DONOR: This protocol will allow the use of donors who are unrelated but are HLA-A, b, C, D/Dr identical and MLC (mixed lymphocyte culture) compatible
• Patient must have adequate insurance to cover the cost of the transplant and hospitalization