ABBA CORD: dCBT w/ Abatacept for aGVHD Prophylaxis

Inclusion Criteria

• Patients with the following hematologic malignancies:

  • Acute myelogenous leukemia (AML): High-risk and intermediate-risk AML including:

    • Antecedent hematological disease (e.g., myelodysplasia (MDS))
    • Treatment-related leukemia
    • Complete Remission (CR1) with poor or intermediate-risk cytogenetics or molecular markers (e.g. Flt 3 mutation, 11q23, del 5, del 7, complex cytogenetics)
    • CR2 or CR3
    • Induction failure or 1st relapse with < 10% blasts in the marrow

  • Acute lymphoblastic leukemia (ALL):

    • High-risk CR1 including:

      • Poor-risk cytogenetics (e.g., Philadelphia chromosome t(9;22)or 11q23 rearrangements)
      • Philadelphia chromosome-like ALL
      • Presence of minimal disease by flow cytometry after 2 or more cycles of chemotherapy

    • No CR within 4 weeks of initial treatment

    • Induction failure with < 10% blasts in the marrow

    • CR2 or CR3

  • Myelodysplastic syndromes (MDS), Intermediate, High or Very High Risk by the revised international prognostic scoring system or treatment related MDS.

  • Bi-phenotypic or mixed-phenotypic acute leukemia in:

    • CR.
    • Induction failure or 1st relapse with < 10% blasts in the marrow.

  • Chronic Myelogenous Leukemia (CML) in second chronic phase after accelerated or blast crisis.

  • Chronic Myelomonocytic Leukemia (CMML)

• Age > or equal to 18 years, < or equal to 65yrs

• KPS > or equal to 80

• Patients without a suitable HLA-matched related or unrelated donor

• Patient with the following CB units:

  • At least two 4-8/8 HLA high resolution matched CB units. Both must have a cell dose of 1.5x107 TNC/kg each and 1.5x105 CD34+/kg
  • A minimum of 1 CB unit as back up.

• Concurrent Therapy for Extramedullary Leukemia or CNS Lymphoma: Concurrent therapy or prophylaxis for testicular leukemia, CNS leukemia, and CNS lymphoma including standard intrathecal chemotherapy and/or radiation therapy will be allowed as clinically indicated. Such treatment may continue until the planned course is completed. Subjects must be in CNS remission at the time of protocol enrollment if there is a history of CNS involvement. Maintenance therapy after transplant is allowed.

• Subjects must have the ability to understand and the willingness to sign a written informed consent document.

Exclusion Criteria

• Patients with inadequate Organ Function as defined by:

  • Creatinine clearance < 50ml/min
  • Bilirubin > 2X institutional upper limit of normal unless Gilbert syndrome
  • AST (SGOT) > 3X institutional upper limit of normal
  • ALT (SGPT) > 3X institutional upper limit of normal
  • Pulmonary function: DLCOc < 60% normal
  • Cardiac: left ventricular ejection fraction < 50

• Patients with uncontrolled inter-current illness including, but not limited to ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements.

• Pregnant or breastfeeding women are excluded from this study because chemotherapy involved with RIC have the significant potential for teratogenic or abortifacient effects.

• Any condition that would, in the investigator's judgment, interfere with full participation in the study, including administration of study drug and attending required study visits; pose a significant risk to the subject; or interfere with interpretation of study data.

• Known allergies, hypersensitivity, or intolerance to any of the study medications, excipients, or similar compounds.

• Presence of donor-specific antibodies against chosen graft source.

• Hematopoietic Cell Transplantation Comorbidity index (HCT-CI) > 5.

• Prior autologous stem cell transplant within the preceding 12 months or prior allogeneic transplant.