RATIONALE: Radiation therapy uses high-energy x-rays to damage tumor cells. Bone marrow
transplantation may be able to replace immune cells that have been destroyed by radiation
therapy used to kill tumor cells. Sometimes the transplanted cells can make an immune
response against the body's normal tissues. Mycophenolate mofetil and tacrolimus may be an
effective treatment for graft-versus-host disease caused by bone marrow transplantation.
PURPOSE: Phase II trial to study the effectiveness of total-body irradiation, tacrolimus,
and mycophenolate mofetil plus bone marrow transplantation in treating patients with
OBJECTIVES: I. Determine whether sustained engraftment of HLA identical sibling marrow can
be achieved in patients treated with total body irradiation before transplant and tacrolimus
and mycophenolate mofetil after transplant. II. Document the nonhematologic toxicities of
this regimen. III. Characterize immune reconstitution of patients during this treatment
regimen. IV. Document the incidence of aplasia and graft-versus-host disease associated with
donor leukocyte infusions when administered after this regimen.
OUTLINE: Patients receive total body irradiation in a single fraction on day -1. Tacrolimus
is given orally twice per day on days -1 to 50. Mycophenolate mofetil is given orally on day
0 and twice per day on days 1 to 28. Patients receive donor bone marrow infusion on day 0.
Patients are evaluated on days 56, 180, 292, and 365. If there is donor engraftment, donor
chimerism is less than 80%, there is no active graft-versus-host disease, no disease
progression, less than 50% decrease in donor cell chimerism from last measurement, and the
patient is not taking immunosuppressive agents, then donor leukocyte infusions are
administered on days 70, 194, and 306. Patients are followed annually for 5 years.
PROJECTED ACCRUAL: A total of 20 patients will be accrued for this study.
DISEASE CHARACTERISTICS: Must have a 6 antigen HLA identical related donor and one of the
following diseases: -Acute myelogenous leukemia in high risk first complete remission or
second or greater complete remission -Acute lymphocytic leukemia in high risk first
complete remission or second or greater remission -Chronic myelogenous leukemia in chronic
phase -Indolent non-Hodgkin's lymphoma (NHL) or aggressive NHL in complete or partial
remission, not eligible for autologous bone marrow transplant (ABMT) -Multiple myeloma in
complete or partial response -Myelodysplastic syndrome -Stage III or IV chronic
lymphocytic leukemia -Hodgkin's disease after first complete remission Patients must also
have one of the following high risk features: -Age 55-70 -Age 18-54 must have one of the
following conditions: LVEF 35-44% FEV1 or FVC 40-49% Bilirubin 2.1-3.0 mg/dL, AST 71-175,
or ALT 81-200 Creatinine 2.1-3.0 mg/dL Disease recurrence less than 1 year after ABMT
Between 18 to 24 months of prior chemotherapy (12 to 24 months for multiple myeloma)
PATIENT CHARACTERISTICS: Age: 18 to 70 Performance status: ECOG 0-2 Life expectancy: Not
specified Hematopoietic: Not specified Hepatic: Bilirubin less than 3.1 mg/dL Renal:
Creatinine less than 3.1 mg/dL Cardiovascular: LVEF at least 35% Pulmonary: FEV1 and FVC
at least 40% of predicted (60% for patients who have received thoracic or mantle
radiotherapy) Other: Not pregnant Fertile patients must use effective contraception Not
PRIOR CONCURRENT THERAPY: See Disease Characteristics