• Overall and event-free survival at 1 year [ Designated as safety issue: No ]
  

• Speed of neutrophil and platelet recovery [ Designated as safety issue: No ]
  
• Incidence and speed of donor-derived engraftment [ Designated as safety issue: No ]
  
• Incidence and severity of acute graft versus host disease (GVHD) at 100 days [ Designated as safety issue: No ]
  
• Incidence and severity of chronic GVHD at 1 year [ Designated as safety issue: No ]
  
• Correlation of incidence of serious infectious complications with immune recovery [ Designated as safety issue: No ]
  
• Response to treatment [ Designated as safety issue: No ]
  
• Incidence of transplant-related mortality at 100 and 180 days [ Designated as safety issue: No ]
  
• Incidence of malignant relapse or disease progression at 1 and 2 years [ Designated as safety issue: No ]
  
• Probabilities of overall and event-free survival at 2 years [ Designated as safety issue: No ]
  

OBJECTIVES:

Primary

• Determine the overall and event-free survival at 1 year in patients with B-cell non-Hodgkin's lymphoma or chronic lymphocytic leukemia treated with a nonmyeloablative conditioning regimen, rituximab, and allogeneic hematopoietic stem cell transplantation.

Secondary

• Determine the speed of neutrophil and platelet recovery in patients treated with this regimen.
• Determine the incidence and speed of donor-derived engraftment in these patients.
• Determine the incidence and severity of acute graft versus host disease (GVHD) at 100 days in patients treated with this regimen.
• Determine the incidence and severity of chronic GVHD at 1 year in patients treated with this regimen.
• Correlate the incidence of serious infectious complications with immune recovery in patients treated with this regimen.
• Determine the response in patients treated with this regimen.
• Determine the incidence of transplant-related mortality at 100 and 180 days in these patients.
• Determine the incidence of malignant relapse or disease progression at 1 and 2 years in these patients.
• Determine the probabilities of overall and event-free survival at 2 years in patients treated with this regimen.

OUTLINE: Patients are stratified according to donor type (HLA-matched related vs HLA-matched unrelated or single HLA allele-disparate related or unrelated).

• Rituximab therapy: Patients receive rituximab IV on day -8 or -7 and on days 21, 28, 35, and 42.
• Nonmyeloablative conditioning: Patients receive fludarabine phosphate IV over 30 minutes on days -6 to -2, cyclophosphamide IV on day -6, and anti-thymocyte globulin (ATG)* IV over 4-6 hours on days -3 and/or -2. Patients undergo total-body irradiation on day -1.

NOTE: *Patients with HLA-matched sibling donors do not receive ATG.

• Allogeneic hematopoietic stem cell transplantation (HSCT): Patients undergo filgrastim (G-CSF)-mobilized allogeneic HSCT on day 0. Patients receive filgrastim (G-CSF) IV or subcutaneously beginning on day 7 and continuing until blood counts recover.
• Graft versus host disease prophylaxis: Patients receive cyclosporine IV over 2-4 hours or orally twice daily on days -3 to 100 followed by a taper and mycophenolate mofetil IV or orally twice daily on days -3 to 45 followed by a taper, in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed every 3-6 months for 2 years and then annually thereafter.

PROJECTED ACCRUAL: A total of 60 patients will be accrued for this study.

DISEASE CHARACTERISTICS:

• Diagnosis of 1 of the following:

  • CD20-positive aggressive B-cell non-Hodgkin's lymphoma (NHL), including any of the following subtypes:

    • Diffuse large cell lymphoma*, meeting 1 of the following criteria:

      • Relapsed disease after initial therapy, but failed to mobilize or had bone marrow involvement and therefore is not suitable for an autologous stem cell transplantation
      • High-intermediate- or high-risk second-line, age-adjusted International Prognostic Index score and in second complete remission (CR) or partial remission (PR) after autologous stem cell transplantation
      • Failed prior autologous stem cell transplantation and in PR or better after salvage chemotherapy

    • Large cell transformation of indolent NHL or chronic lymphocytic leukemia (CLL), meeting the following criteria:

      • In CR or PR of the large cell component of disease after salvage chemotherapy or autologous stem cell transplantation

    • Mantle cell lymphoma*, meeting 1 of the following criteria:

      • High-risk disease (e.g., p53 positivity) and in first CR or PR after initial therapy
      • Relapsed disease after initial therapy and in second or third CR or PR after salvage chemotherapy NOTE: *No progressive disease at allograft work-up

  • CD20-positive indolent NHL (e.g., follicular lymphoma, small cell lymphoma, or marginal zone NHL) OR CLL

    • Second or subsequent progression (pre-allograft cytoreduction necessary, but CR or PR not required)
• Relapsed disease must be biopsy-proven

• Must have received pre-allograft salvage chemotherapy, including 1 of the following:

  • Single autologous stem cell transplantation using high-dose chemotherapy conditioning within the past 120 days
  • At least 2 courses of intensive combination chemotherapy (e.g., RICE [rituximab, ifosfamide, carboplatin, etoposide]), according to diagnosis, within the past 60 days
  • If further combination chemotherapy is not appropriate (for heavily pretreated CLL patients), 2-3 courses of single-agent, intermediate-dose cyclophosphamide is required within the past 60 days

• HLA-compatible related or unrelated donor available

  • HLA-matched ≥ 9/10 of the A, B, C, DRB1, and DQB1 loci, as tested by high resolution typing

    • One allele mismatch allowed

PATIENT CHARACTERISTICS:

• Karnofsky performance status 70-100%
• Creatinine < 1.2 mg/mL OR creatinine clearance ≥ 50 mL/min
• Bilirubin < 2.5 mg/dL
• AST and ALT ≤ 3 times upper limit of normal (unless benign congenital hyperbilirubinemia is present)
• Spirometry and corrected DLCO ≥ 50% of normal
• LVEF ≥ 40%
• Albumin ≥ 2.5 g/dL
• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception
• No active uncontrolled infection, including active infection with Aspergillus or other mold
• No HIV infection
• No hepatitis B antibody or antigen positivity

PRIOR CONCURRENT THERAPY:

• See Disease Characteristics
• No prior allogeneic transplantation