Treatment of Single or Double Umbilical Cord Trans + Graft-versus-host Disease (GVHD) Prophylaxis w/ Tacrolimus & Mycophenolate Mofetil

Patient and UCB Unit Selection:

Inclusion Criteria: General (Adults and Pediatrics)

Only one of the following should be present:

Acute leukemia (lymphocytic or myeloid or undifferentiated or biphenotypic) in complete remission 2 or beyond
Acute lymphocytic leukemia, Philadelphia chromosome positive in complete remission 1 or beyond
Acute myeloid leukemia in complete remission 1 if it has evolved from a myeloproliferative disorder (MPD) or myelodysplastic syndrome (MDS).
Acute leukemia in complete remission 1 if there is a failure to recover normal blood counts or the development of MDS following induction chemotherapy.
Therapy related acute leukemia in complete remission 1 or beyond
Chronic myeloid leukemia (CML) chronic phase-1 (imatinib failures, imatinib intolerance), or any CML beyond first chronic phase
Myelodysplastic syndromes (Intermediate -1 or higher risk by IPSS)
Therapy related MDS (irrespective of IPSS)
Multiple myeloma must have had prior chemotherapy or autologous transplant
Chronic lymphocytic leukemia must have failed two lines of conventional therapy but still chemosensitive to third line therapy.
Chemosensitive Non-Hodgkin's lymphoma or Hodgkin's lymphoma in CR or PR after failing induction therapy.
High risk acute leukemia/lymphoma eg Nk/T cell, HTLV associated leukemia/lymphoma, other T cell lymphoma/leukemia in first best response
For patients with acute leukemia-they must be in a remission (less than 5% leukemic marrow blasts) at time of study entry.

Inclusion Criteria (Adults - 18 years or older)

Karnofsky score of > 70%
Estimated creatinine clearance of > 60 ml/min
Left ventricular ejection fraction of >50%
Pulmonary function test with DLCO, FEV1 and FVC of >60%
Total bilirubin and SGOT of < 3.0 x upper limits of normal
Note: Age 18- 40 years for adult myeloablative conditioning Age > 40 -50 years for adult reduced intensity conditioning

Inclusion Criteria (Pediatrics - 18 years and younger)

Karnofsky or Lansky score of > 70%
Estimated Creatinine clearance of > 60 ml/min
Left ventricular ejection fraction of >50%
Pulmonary function test with FEV1 and FVC of >60% (for patients >6 years of age)
Total bilirubin and SGOT of < 3.0 x upper limits of normal
Note: All pediatric patients will receive myeloablative conditioning

Inclusion Criteria - Donor Issues

No available HLA identical or 1 antigen/allele mismatched (Class I-A, B or Class II DR locus) related donor

Inclusion Criteria: Umbilical Cord Blood Unit-HLA Typing

At least a HLA 4/6 match (Class I-A, B by low resolution, Class II-DR by high resolution) to recipient
For double UCB SCT each unit should be at least a 4/6 match (Class I-A,B by low resolution, Class II-DR by high resolution) to recipient, and should be at least a 4/6 match (Class I-A,B by low resolution, Class II-DR by high resolution) to each other

Inclusion Criteria: Umbilical Cord Blood Unit-Cell dose

For Single UCB SCT: the unit will have ≥ 3.5 X 107 NC/kg of recipient body weight (For pediatric patients a cell dose ≥ 3.0 X 107 NC/kg of recipient body weight is acceptable). Recipient body weight will be determined as per standard guidelines.
For Double UCB SCT: (done only if no single UCB unit ≥ 3.5 X 107 NC/kg of recipient body weight is available for adults, and ≥ 3.0 X 107 NC/kg of recipient body weight is available for pediatric patients )
The larger of the two units (UCB1) will have a minimum cell dose of 2.0 X 107 NC/kg of recipient body weight. The smaller of the two units (UCB2) will have a minimum of 0.5 X 107 NC/kg of recipient body weight.

The total cell dose UCB1 + UCB2 will be ≥ 2.5 X 107 NC/kg of recipient body weight.

-Adult patients eligible for a double UCB SCT but without an appropriate second UCB unit will be enrolled in the study if their single UCB unit contains ≥ 2.5 x 107 NC/kg recipient body weight.

Exclusion Criteria

Organ dysfunction as per standard guidelines. Unable to give informed consent (for adults only)
Pregnant or lactating
Sexually active individuals capable of becoming pregnant or causing a pregnancy who are unable or unwilling to use appropriate contraceptives.
Active use of illicit drugs as evidenced by a positive toxicology screen for a substance not prescribed by a medical professional just prior to initiating the preparative regimen
Actively smoking as evidenced by a positive nicotine screen just prior to initiating the preparative regimen
HIV positive
Patients with other unrelated malignancies will be excluded except:
diagnosis of skin cancer (squamous cell or basal cell)
diagnosis of cervical dysplasia (CIN I-III)
any other malignancy which is currently in remission and was treated with curative intent more than 5 years preceding study entry
In patients with secondary MDS or secondary acute leukemias-the previous non-hematopoietic neoplasm should be in remission but can be within 5 years of study entry