Stem Cell Transplant for Hematologic Diseases

Before treatment begins, stem cells will be collected from the donor's blood or bone marrow.
The stem cells will be collected and frozen before we start to give the patient
chemotherapy.

After admission to the hospital, patients will receive total body irradiation (very strong
x-rays that kill cells in the bone marrow), Fludarabine and Campath 1H prior to the stem
cell transplant (infusion of the donor's stem cells).

Starting 7 days after the transplant, the patient will be given G-CSF by subcutaneous
injection, until a blood test shows that numbers of granulocytes (a type of white blood
cell) in the blood are more than 1,000/uL. This is to help increase blood cell counts.

After transplantation, the patient will undergo several evaluations at different times.
These are standard evaluations and tests performed for any patient who has received a stem
cell transplant, as part of routine clinical monitoring.

We will also be looking at the patient's immune function (how the body protects itself to
prevent and fight infections and diseases). To do this, blood tests will be performed at
regular intervals (every 3 to 6 months) for 2 years.

Depending on how well the donor stem cells work in the body after the transplant, the
patient may receive one or more Donor Leukocyte Infusions (DLI). This is when leukocytes (a
type of white blood cell) collected from the same donor that provided the stem cells are
given to the patient through a central line into a vein.

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,
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; 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); 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 from 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. This 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 greatest number of MHC loci. Matching will be
determined by Class I and Class II DNA typing. The donor should be sufficiently
healthy as to not be at increased risk from the stem cell 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 legal representative and/or legal guardian 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 3X
upper limit of normal.

10. Unstable cerebral vascular disease and recent hemorrhagic stroke (less than 6
months).

11. Active CNS disease from hematological disorder.