Cord blood boost: new technique shows promise for tough leukemia cases

Copied word for word from the study's registry entry, so the wording is the study team's rather than ours.

Inclusion Criteria: 1. High and very high-risk hematologic malignancy defined as: 1. Acute Myeloid Leukemia (Primary induction failure, Chemorefractory relapse, Relapse after allogeneic or autologous transplant, High risk AML in CR1, ≥ CR2) 2. Acute Lymphoid leukemia (Primary induction failure, High risk ALL in CR1, ≥ CR2, Chemorefractory relapse, Relapse after allogeneic or autologous transplant) 3. Myelodysplastic syndrome (Relapse after allogeneic or autologous transplant, ≥10% blasts within 30 days of start of conditioning regimen, Poor and very poor cytogenetics abnormalities, CMML with HCT-specific CPSS score high or intermediate-2, Stable disease, Progressive disease while on azacitidine). 4. Chronic myelogenous leukemia (Patients who progressed to blast crisis) 2. Availability of 2 CBs ≥ 4/6 HLA match with pre-freeze CD34+ cell count ≥0.5 x 10E5/kg and TNC≥1.5 x 10E7/kg 3. Karnofsky ≥70. 4. LVE fraction ≥ 40% or fractional shortening \>22% 5. FVC, FEV1 and DLCOc ≥ 50% of predicted 6. Bilirubin \< 2 x ULN; AST and ALT ≤ 2.5 x ULN; alkaline phosphatase ≤ 5 x ULN. 7. Creatinine \< 2.0 mg/dl. 8. HCT-CI ≤3 if patients have ≥5% blasts in the bone marrow and HCT-CI ≤5 if 60-65 years old. Exclusion Criteria: 1. Allogeneic myeloablative transplant within 6 months. 2. Autologous hematopoietic stem cell transplant within 6 months. 3. Active or recent invasive fungal infection. 4. Presence of a malignancy other than the one for which the UCB transplant is being performed and the expected survival related to the malignancy is estimated to be less than 75% at 5 years. 5. HIV positivity. 6. Hepatitis B or C infection with measurable viral load. 7. Liver cirrhosis. 8. Pregnancy, breastfeeding or unwillingness to use appropriate contraception. 9. Any abnormal condition or laboratory result that is considered by the principal investigator capable of altering patient condition or study outcome. 10. Active central nervous system involvement. 11. Chloroma \> 2 cm.