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