Allogeneic Transplantation Using Total Lymphoid Irradiation (TLI) and Anti-Thymocyte Globulin (ATG) for Older Patients With Hematologic Malignancies

This study will evaluate if TLI-ATG conditioning followed by allogeneic hematpoietic cell
transplant (HCT), which has provided excellent overall survival for patients with relapsed
lymphoma after failed autologous HCT, provides a similar benefit in the setting of elderly
patients with hematologic malignancies.

INCLUSION CRITERIA:

- Any patient with one of the following hematolymphoid malignancies or syndromes in whom
allogeneic hematopoietic stem cell transplant (HST) is warranted. Specific disease
categories include:

- Indolent advanced stage non-Hodgkin lymphomas

- Mantle cell lymphoma

- Chronic lymphocytic leukemia

- Hodgkin disease (Hodgkin's lymphoma)

- Acute leukemias in complete remission

- Aplastic anemia

- Paroxysmal nocturnal hemoglobinuria

- Myelodysplastic or myeloproliferative syndromes.

- Other selected malignancies/disorders may also be considered but must be approved
by the transplant team and the Principal Investigator.

- Age > 50 years, or if < 50 years of age, considered to be at high risk for
regimen-related toxicity associated with conventional myeloablative transplants due to
pre-existing medical conditions or prior therapy.

- A fully human leukocyte antigen (HLA)-identical sibling or matched unrelated donor is
available. Potential participants with one antigen mismatched donors can be considered
but only after discussion with the transplant team and the Principal Investigator.

- Participant must be competent to give consent.

EXCLUSION CRITERIA:

- Progressive hematolymphoid malignancies despite conventional therapies, or acute
leukemias not in complete remission.

- Uncontrolled central nervous system (CNS) involvement with disease

- Fertile men or women unwilling to use contraceptive techniques during and for 12
months following treatment

- Pregnant

- Cardiac ejection fraction < 30%

- Uncontrolled cardiac failure

- Pulmonary diffusing capacity (DLCO) < 40% predicted

- Elevation of bilirubin to > 3 mg/dL

- Transaminases > 4 x the upper limit of normal

- Creatinine clearance < 50 cc/min (24-hour urine collection)

- Karnofsky performance score < 60%

- Poorly controlled hypertension on multiple antihypertensives

- Documented fungal disease that is progressive despite treatment

- HIV-positive. Other viral infections, ie, Hepatitis B- and C- positive, evaluated on a
case-by-case basis

- Psychiatric disorders or psychosocial problems which in the opinion of the primary
physician or Principal Investigator would place the patient at unacceptable risk from
this regimen.