Stem Cell Transplant for Hematologic Diseases (HIMSUM)

INCLUSION CRITERIA:

1. Diagnosis of myelodysplastic disorders, Fanconi's anemia, Acute Myelogenous Leukemia (including secondary), Acute Lymphoblastic Leukemia, Multiple Myeloma, Plasma Cell Dyscrasia, Lymphoproliferative disorders (Non-Hodgkin Lymphoma, Hairy Cell Leukemia, or Chronic Lymphocytic Leukemia and Hodgkin's Disease). Diagnosis of Myelodysplastic disorders which is not good risk by IPSS, Fanconi's anemia, Acute Myelogenous Leukemia (1st or subsequent relapse or 2nd or subsequent CR or refractory disease), Acute Lymphoblastic Leukemia in 2nd or subsequent remission or relapse or refractory disease, or Philadelphia chromosome positive, Chronic Myelogenous Leukemia (failed STI and interferon), Multiple Myeloma (stage II or III), Lymphoma, Chronic Lymphocytic Leukemia (primary refractory or recurrent disease), Hodgkin's Disease (after relapse), Hemophagocytic Lymphohistiocytosis (failed chemotherapy and/or anti-viral therapy), or bone marrow failure such as Aplastic Anemia and Paroxysmal nocturnal hemoglobinuria, PNH (failed prior therapies).
2. Conditions that increase treatment related mortality: (need one or more to be eligible): Age > / = 50 years; EF of less than 45%; DLCO less than 50% or FEVI 50-75% of predicted value; Diabetes Mellitus; Renal Insufficiency (but creatinine clearance not less than 25 ml/min); Prior recent history of systemic fungal infection; 3rd or greater remission of AML or ALL; Significant grade III or IV neurologic or hepatic toxicity from previous treatment; More than 1 year of diagnosis (CML or Myeloma patients ONLY); Multiple types of treatment regimens (equal to or more than 3); significant Grade III or IV neurologic or hepatic toxicity from previous treatment; Prior autologous or allogeneic stem cell transplantation.

3. Haploidentical family member donor. The protocol is open to patients who lack a 5/6 or 6/6 HLA antigen matched donor. Due to the increased risk of GVHD, patients with Fanconi anemia and a 5/6 HLA match will also be eligible.

   For this protocol, the "best" donor will be defined as a first-degree haploidentical family member who matches at the most MHC loci. Matching will be determined by class I and class II DNA typing. The donor should be sufficiently healthy not to be at increased risk from the mobilization procedure. Should more than one "equally" MHC incompatible donor be identified, other selection criteria will include: age and size of donor, CMV status and sex. The Principal Investigator will make final decisions.

4. Available healthy donor without any contraindications for donation.
5. Patient and/or responsible person able to understand and sign consent.
6. Age between birth and 70 years.
7. Women of child bearing potential must have a negative pregnancy test.

EXCLUSION CRITERIA:

1. Pregnant, lactating or unwilling to use contraception.
2. HIV positive patient.
3. Uncontrolled intercurrent infection.
4. Untreated Blast Crisis for CML.
5. Uncontrolled High-grade lymphoproliferative disease / lymphoma.
6. Unstable angina and uncompensated congestive heart failure (Zubrod of 3 or greater).
7. Severe chronic pulmonary disease requiring oxygen (Zubrod of 3 or greater).
8. Hemodialysis dependent.
9. Active hepatitis or cirrhosis with total bilirubin, SGOT, and SGPT greater than 3 x upper limit of normal.
10. Unstable Cerebral vascular disease and recent hemorrhagic stroke (less than 6 months).
11. Active CNS disease from hematological disorder.