Chemotherapy, Radiation Therapy, and Peripheral Stem Cell Transplantation in Treating Patients With Hematologic Cancer

OBJECTIVES: I. Determine the maximum tolerated dose of T-cells photochemically treated with
psoralen and ultraviolet A given with peripheral stem cell transplantation in patients with
hematologic malignancies or bone marrow failure myelodysplastic syndrome. II. Assess the
toxicity of this treatment in these patients. III. Evaluate this regimen in terms of
prevention of graft versus host disease and control of malignancy in these patients.

OUTLINE: This is a dose escalation, multicenter study of T-cells photochemically treated with
psoralen and ultraviolet A. Patients receive thiotepa IV over 2 hours on day 1,
cyclophosphamide IV over 2 hours on days 2 and 3, and whole body radiotherapy on days 5-8.
Patients undergo preserved stem cell or bone marrow allogeneic transplant plus psoralen
treated T-cell allogeneic transplant on day 9. Cohorts of 3-6 patients receive escalating
doses of photochemically treated T-cells until the maximum tolerated dose (MTD) is
determined. The MTD is defined as the dose preceding that at which at least 2 of 3 patients
experience dose limiting toxicities. Patients are followed for 100 days.

PROJECTED ACCRUAL: A maximum of 37 patients will be accrued for this study.

DISEASE CHARACTERISTICS: Hematologic malignancy, including acute myeloid or lymphoid
leukemia of any FAB subtype, not in remission with chemotherapy or requiring bone marrow
transplant OR Chronic myeloid leukemia, advanced beyond first chronic phase OR
Myelodysplasia, including secondary to prior chemotherapy, with: Granulocyte count less
than 500/mm3 OR Platelet count less than 50,000/mm3 OR High risk cytogenetic abnormalities
such as +8, -7, -5, or 11q23 OR Intermediate or high grade lymphoma without response to
initial therapy or in relapse OR Multiple myeloma without response to initial therapy or in
relapse OR Stage IV low grade lymphoma or chronic lymphocytic leukemia not achieving
remission with 2 regimens No aplastic anemia Related haploidentical donor (1-3 HLA-A, B,
and/or DR mismatch) for collection of stem cells and whole blood T-cells required

PATIENT CHARACTERISTICS: Age: 6 months to 49 years Performance status: ECOG 0-2 Life
expectancy: Greater than 12 weeks Hematopoietic: See Disease Characteristics Hepatic:
Bilirubin less than 1.5 mg/dL SGPT less than 3 times upper limit of normal Renal:
Creatinine less than 1.5 mg/dL Cardiovascular: Left ventricular ejection fraction at least
45% No symptoms or active treatment of left ventricular failure Pulmonary: Corrected DLCO
at least 50% Other: No acute viral, bacterial, or fungal infection No prior transfusion
associated graft versus host disease No other medical condition that would preclude study
Not pregnant or nursing Negative pregnancy test Fertile patients must use effective
contraception

PRIOR CONCURRENT THERAPY: Biologic therapy: At least 3 weeks since prior immunotherapy or
interferon alfa and recovered No prior autologous or allogeneic progenitor cell transplant
Chemotherapy: See Disease Characteristics At least 3 weeks since prior chemotherapy and
recovered Endocrine therapy: Not specified Radiotherapy: At least 3 weeks since prior
radiotherapy and recovered Surgery: Not specified