T-cell Recovery in Patients With Leukemia, Advanced Lymphoma, Myelodysplastic Syndrome, or Myeloproliferative Disorder Receiving Alemtuzumab and Undergoing Donor Stem Cell Transplant

OBJECTIVES:

Primary

- To define the biologic recovery and behavior of T-regulatory cells in patients
undergoing stem cell transplantation.

- To determine if the administration of alemtuzumab as part of conditioning therapy to
patients undergoing stem cell transplantation from mismatched-related donors or from
matched-unrelated donors permits T-regulatory cell recovery.

OUTLINE: This is a multicenter study.

- Stem cell transplantation conditioning regimen: Patients receive cytarabine IV every 12
hours for 6 doses starting on day -8*, cyclophosphamide IV once daily on days -7 and
-6, alemtuzumab IV on days -4 to -1, and undergo total body irradiation (TBI) twice
daily on days -4 to -1 (total of 8 fractions). Patients with CNS disease will receive
additional irradiation to the craniospinal axis.

NOTE: *Patients with T-cell lymphoma do not receive cytarabine.

- Stem cell transplantation: Patients undergo stem cell transplantation on day 0.

- Graft-versus-host-disease (GVHD) prevention: Patients receive tacrolimus IV beginning
on day -2, and continuing according to institutional guidelines, followed by a taper.
Patients also receive methotrexate IV on days +1, +3, +6, and +11.

Blood or bone marrow samples will be collected periodically for regulatory T-cell assay.

After completion of study treatment, patients are followed once a month for 6 months, at 9
months, and at 1, 2, and 3 years.

DISEASE CHARACTERISTICS:

- Diagnosis of 1 of the following:

- Acute or chronic leukemia

- Advanced Hodgkin or non-Hodgkin lymphoma

- Myelodysplastic/myeloproliferative disease

- Unlikely to be cured by standard chemotherapy treatments

- Relapsed after standard chemotherapy treatments

- In first remission with unfavorable prognostic features

- Must have either a one HLA antigen mismatched-related donor or an HLA
matched-unrelated donor using the standard 6 HLA antigen profile (HLA class I, A and
B, and HLA class II, DRB1)

PATIENT CHARACTERISTICS:

- Karnofsky performance status (PS) 70-100% or Lansky PS 50-100%

- Life expectancy > 6 weeks unless limited by leukemia

- No evidence of symptomatic cardiac dysfunction by echocardiogram (i.e., shortening
fraction < 20%)

- Creatinine ≤ 3 times normal for age

- FVC ≥ 40% of predicted

- Direct bilirubin ≤ 3 mg/dL

- AST ≤ 500 IU/L

- No severe personality disorder or mental illness

- No severe infection that, in the estimation of the principal investigator, prohibits
the use of ablative chemotherapy

- No documented HIV positivity

PRIOR CONCURRENT THERAPY:

- See Disease Characteristics