Fludarabine, Cyclophosphamide, and Total-Body Irradiation in Treating Patients Who Are Undergoing a Donor Bone Marrow Transplant for Hematologic Cancer

DISEASE CHARACTERISTICS:

Diagnosis of 1 of the following hematologic malignancies:

Acute leukemia

In second or subsequent complete remission (CR), as defined by absence of abnormal blast population by flow cytometry

In first CR with any of the following poor-risk cytogenetic features:

Alteration of chromosome 5 or 7
Multiple abnormalities
Philadelphia chromosome positive

Chronic phase chronic myelogenous leukemia (CML)

In first chronic phase and refractory to interferon alfa or imatinib mesylate
In second or subsequent chronic phase

Chronic lymphocytic leukemia, meeting 1 of the following criteria:

Received prior chemotherapy with a nucleoside analog and had remission lasting < 6 months

Received 1 prior therapy and has any of the following high-risk features:

Cytogenetic abnormalities of 17p, 11q
Mutations of the Zap70 gene
Somatically unmutated immunoglobulin heavy chain variable region genes

Hodgkin's lymphoma

Ineligible for autologous stem cell transplantation (SCT) due to any of the following exclusion factors:

LVEF < 45%
FEV_1 or FVC < 50% of predicted (75% of predicted in patients with prior thoracic or mantle radiotherapy)
Total bilirubin > 2.0 mg/dL (unless documented Gilbert's disease)
Creatinine > 2.0 mg/dL

Non-Hodgkin's lymphoma (NHL)

Low-grade NHL allowed provided patient had a remission duration of < 1 year after administration of any established, multi-agent chemotherapy regimen (e.g., CVP, CHOP, or rituximab in combination with CHOP)
Intermediate- or high-grade NHL allowed provided patient is ineligible for autologous SCT according to the criteria listed above
Multiple myeloma
Myelodysplastic syndromes
Paroxysmal nocturnal hemoglobinuria

Chronic myeloproliferative disorders other than CML, including any of the following:

Chronic myelomonocytic leukemia
Agnogenic myeloid metaplasia (or myeloid metaplasia with myelofibrosis), with hemoglobin < 10 g/dL OR WBC < 4,000/mm^3 or > 30,000/mm^3

Polycythemia vera or essential thrombocythemia in "spent" phase, with a history of 2 of the following:

Marrow fibrosis
Splenomegaly
Cytopenia (i.e., absolute neutrophil count < 1,500/mm^3, platelet count < 100,000/mm^3, hemoglobin < 10 g/dL)
Polycythemia vera or essential thrombocythemia with transformation to myelodysplastic syndromes or acute myeloid leukemia (requires treatment to achieve < 20% blasts in marrow)
No smoldering myeloma
Patients with acute myeloid leukemia or myelodysplastic syndromes must have had comprehensive cytogenetic evaluation of bone marrow specimen during active disease
Ineligible for or refused bone marrow transplantation from an HLA-matched sibling or unrelated donor
Ineligible for or refused autologous SCT

Must have an HLA mismatched (i.e., 3/6, 4/6, or 5/6) related (first-degree relative)* donor available

Donor ≥ 18 years of age NOTE: *Patients with an inherited recombinant HLA haplotype may receive marrow from the parent in whose gamete the recombination occurred

NOTE: A new classification scheme for adult non-Hodgkin's lymphoma has been adopted by PDQ. The terminology of "indolent" or "aggressive" lymphoma will replace the former terminology of "low", "intermediate", or "high" grade lymphoma. However, this protocol uses the former terminology.

PATIENT CHARACTERISTICS:

Age

6 months to 74 years

Performance status

ECOG 0-1

Life expectancy

Not specified

Hematopoietic

See Disease Characteristics

Hepatic

See Disease Characteristics
Bilirubin < 3.1 mg/dL

Renal

See Disease Characteristics

Cardiovascular

See Disease Characteristics
LVEF ≥ 35%

Pulmonary

See Disease Characteristics
FEV_1 or FVC ≥ 40% of predicted in patients without prior thoracic or mantle radiotherapy (60% of predicted in patients with prior thoracic or mantle radiotherapy)

Other

Not pregnant or nursing
Negative pregnancy test
Fertile patients must use effective contraception
HIV negative
Geographically accessible
No debilitating medical or psychiatric illness that would preclude giving informed consent or receiving optimal treatment or follow-up

PRIOR CONCURRENT THERAPY:

Biologic therapy

See Disease Characteristics
No prior transfusions from donor

Chemotherapy

See Disease Characteristics

Endocrine therapy

Not specified

Radiotherapy

See Disease Characteristics

Surgery

Not specified