Cord Blood Transplant in Adults with Blood Cancers

Eligibility Criteria

• * I. Acute myelogenous leukemia (AML):
• * Complete first remission (CR1) at high risk for relapse such as any of the following:
• * Known prior diagnosis of myelodysplasia (MDS) or myeloproliferative disorder (MPD).
• * Therapy-related AML.
• * Presence of extramedullary leukemia at diagnosis.
• * Requirement for 2 or more inductions to achieve CR1.
• * Intermediate or high ELN2017 genetic risk AML.
• * Any patient unable to tolerate consolidation chemotherapy as would have been deemed appropriate by the treating physician.
• * Other high-risk features not defined above.
• * Complete second remission (CR2) or greater (CR2+).
• * Patients in morphologic remission with persistent cytogenetic, flow cytometric, or molecular aberrations are eligible
• * Complete first remission (CR1) at high risk for relapse such as any of the following:
• * Presence of any high-risk cytogenetic abnormalities such as t(9;22), t(1;19), t(4;11) or other MLL rearrangements (11q23) or other high-risk molecular abnormality.
• * Failure to achieve MRD- complete remission after induction therapy.
• * Persistence or recurrence of minimal residual disease on therapy.
• * Any patient unable to tolerate consolidation and/or maintenance chemotherapy as would have been deemed appropriate by the treating physician.
• * Other high-risk features not defined above.
• * Complete second remission (CR2) or greater (CR2+). Note: ALL with less than 5% blasts at time of transplant but persistent cytogenetic, flow cytometric or molecular aberrations are eligible.
• * International prognostic scoring system (IPSS) risk score of INT-2 or high risk at the time of diagnosis.
• * Any IPSS risk category if life-threatening cytopenia(s) exists.
• * Any IPSS risk category with karyotype or genomic changes that indicate high risk for progression to acute myelogenous leukemia.
• * MDS/MPD overlap syndromes without myelofibrosis.
• * MDS/ MPD patients must have less than 10% bone marrow myeloblasts and ANC \> 0.2 (growth factor supported if necessary) at transplant work-up.
• * Karnofsky score equal or greater than 80% (See Appendix B; inpatient Leukemia service transfers without discharge are acceptable provided patient has equivalent KPS as if were outpatient).
• * Calculated creatinine clearance \> 70 ml/min.
• * Bilirubin \< 1.5 mg/dL (unless benign congenital hyperbilirubinemia or hemolysis).
• * ALT \< 3 x upper limit of normal (ULN).
• * Pulmonary function: Spirometry (FVC and FEV1) and corrected DLCO) \> 60% predicted.
• * Left ventricular ejection fraction (MOD-bp)\> 50%.
• * Albumin \> 3.0.
• * Hematopoietic Cell Transplantation Comorbidity index (HCT-CI) ≤5.
• * Each CB unit must be at least 3/8 HLA-matched to the patient considering high-resolution 8-allele HLA typing. \[Taken from the Cord Blood Summary\]
• * Each CB unit will be required to have a cryopreserved TNC dose of at least 1.5 x 10\^7 TNC/ recipient body weight (TNC/ kg). \[Taken from the Cord Blood Summary\]
• * Each CB unit will be required to have a cryopreserved CD34+ cell dose of at least 1.5 x 10\^5 CD34+ cells/ recipient body weight (CD34+ cells/kg). \[Taken from the Cord Blood Summary\]
• * A minimum of one unit will be reserved as a backup graft. \[Taken from the Cord Blood Summary\]
• * Each CB unit will be required to be cryopreserved in standard cryovolume (24-27 ml/s per unit or per bag if unit in two bags) and be red blood cell depleted. \[Taken from the Cord Blood Summary\]
• * Diagnosis of myelofibrosis or other malignancy with moderate-severe bone marrow fibrosis.
• * Patients with persistent with CNS involvement in CSF or CNS disease at time of screening
• * Prior checkpoint inhibitors/ blockade in the last 12 months.
• * Two prior stem cell transplants of any kind.
• * One prior autologous stem cell transplant within the preceding 12 months.
• * Prior allogeneic transplantation.
• * Prior involved field radiation therapy that would preclude safe delivery of 400cGy TBI in the opinion of Radiation Oncology.
• * Active and uncontrolled infection at time of transplantation.
• * HIV infection.
• * Seropositivity for HTLV-1.
• * Inadequate performance status/ organ function.
• * Pregnancy or breast feeding.
• * Patient or guardian unable to give informed consent or unable to comply with the treatment protocol including appropriate supportive care, long-term follow-up, and research tests.