Umbilical Cord Blood Transplantation From Unrelated Donors

Eligibility Criteria

• * Appropriate diagnosis: Patients must have a disease or syndrome amenable to therapy with hematopoietic stem cell transplantation. Diagnoses include, but are not limited to:
• * Congenital and Other Non-malignant Disorders:
• * Immunodeficiency disorders (e.g. Severe Combined Immunodeficiency, Wiskott-Aldrich Syndrome)
• * Congenital hematopoietic stem cell defects (e.g. Chediak-Higashi Syndrome, Congenital Osteopetrosis, Osteogenesis Imperfecta)
• * Metabolic disorders (e.g. Hurler's Syndrome)
• * Severe aplastic anemia
• * High-Risk Leukemia:
• * Acute Myelogenous Leukemia
• * Refractory to standard induction therapy (more than 1 cycle required to achieve remission)
• * Recurrent (in CR ≥ 2)
• * Treatment-related AML or MDS
• * Evolved from myelodysplastic syndrome
• * Presence of FLT3 abnormalities
• * FAB M6 or M7
• * Adverse cytogenetics
• * Myelodysplastic Syndrome
• * Acute Lymphoblastic Leukemia including T lymphoblastic leukemia:
• * Refractory to standard induction therapy (time to CR \>4 weeks)
• * Recurrent (in CR ≥ 2)
• * WBC count \>30,000/mcL at diagnosis
• * Age \>30 at diagnosis
• * Adverse cytogenetics, such as t(9:22), t(1:19), t(4:11), and other MLL rearrangements.
• * Chronic Myelogenous Leukemia in accelerated phase or blast crisis
• * Biphenotypic or undifferentiated leukemia
• * Burkitt's leukemia or lymphoma
• * Lymphoma:
• * Large cell, Mantle cell, Hodgkin lymphoma refractory or recurrent, chemo-sensitive, and ineligible for an autologous stem cell transplant or previously treated with autologous SCT
• * Marginal zone or follicular lymphoma that is progressive after at least two prior therapies
• * Multiple Myeloma, recurrent following high-dose therapy and autologous SCT or ineligible for an autologous HSCT
• * Solid tumors, with efficacy of allogeneic HSCT demonstrated for the specific disease and disease status
• * Adequate organ function:
• * Cardiac - LVEF \>45%, or shortening fraction \>25%, Absence of congestive heart failure or conduction disturbances with high risk for sudden death
• * Pulmonary - DLCO (corrected for hemoglobin), FEV1 and FVC ≥ 50% predicted;
• * Renal - serum Cr \< 1.5 times the upper limit of normal for age or GFR ≥ 50 ml/min/1.73m2
• * Hepatic - total bilirubin level \< 2 times the upper limit of normal (except for patients with Gilbert's syndrome or hemolysis); if the primary disease process is causal, this criterion will be reconsidered. ALT, AST, and Alkaline phosphatase ≤ 5 times upper limit of normal.
• * Performance Status Karnofsky or Lansky score ≥ 70%.
• * Informed Consent must be obtained prior to initiating conditioning therapy.
• * Receipt of viable cord blood product(s), single or dual, must be confirmed with the stem cell processing laboratory prior to initiating conditioning therapy.
• * Availability of 10/10 or 9/10 HLA-matched related or unrelated donor within a reasonable timeframe dictated by the clinical urgency of the transplant
• * Autologous HSCT \< 6 months prior to proposed UCB transplant
• * Pregnant or breast feeding
• * Current uncontrolled infection
• * Evidence of HIV infection or positive HIV serology