Reduced Intensity Conditioning and Haploidentical Related Bone Marrow for Patients With Hematologic Diseases

Inclusion Criteria:

- Must be <75 years old with no 7/8 or 8/8 HLA-matched sibling donor

- One or more potential related mismatched donors (e.g. biologic parent (s) or siblings
(full or half) or children). Low resolution using DNA based typing at HLA-A, -B and
-DRB1 for potential haploidentical donors is required.

- All diseases listed below are advanced hematologic malignancies not curable by
conventional chemotherapy. Responses to conventional treatment range from zero to 30%
but are typically short lived.

- Acute Lymphoblastic Leukemia (ALL) in first complete remission (CR1) that is NOT
considered favorable-risk.

- Acute Myelogenous Leukemia (AML) in first complete remission (CR1) that is NOT
considered as favorable-risk.

- Acute Leukemias in 2nd or subsequent CR

- Biphenotypic/Undifferentiated/Prolymphocytic Leukemias in first or subsequent CR,
adult T-cell leukemia/lymphoma in first or subsequent CR

- Burkitt's lymphoma in CR2 or subsequent CR

- Natural killer cell malignancies after response to initial therapy

- Chronic myelogenous leukemia: all types except refractory blast crisis.

- Large-cell lymphoma, Hodgkin lymphoma and multiple myeloma with chemotherapy
sensitive disease that has failed or patients who are ineligible for an
autologous transplant.

- Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), marginal zone
B-cell lymphoma, follicular lymphoma, which have progressed within 12 months of
achieving a partial or complete remission.

- Lymphoplasmacytic lymphoma, mantle-cell lymphoma, prolymphocytic leukemia are
eligible after initial therapy if chemotherapy sensitive.

- Refractory leukemia or MDS These patients may be taken to transplant in aplasia
after induction or re-induction chemotherapy or radiolabeled antibody.

- Bone marrow failure syndromes, except for Fanconi Anemia

- Myeloproliferative syndromes

- Adequate organ function is defined as:

- Cardiac: Absence of decompensated congestive heart failure, or uncontrolled
arrhythmia and left ventricular ejection fraction > 35%. For children that are
not able to cooperate with MUGA and echocardiography, such should be clearly
stated in the physician's note

- Pulmonary: DLCO > 30% predicted, and absence of O2 requirements. For children
that are not able to cooperate with PFTs, a pulse oximetry with exercise should
be attempted. If nether test can be obtained it should be clearly stated in the
physician's note.

- Liver: Transaminases < 5 x upper limit of normal and bilirubin < 3 x upper limit
of normal

- Renal: serum creatinine < 2.0 mg/dl (adults) or glomerular filtration rate (GFR)
>40 mL/min/1.73m2 (peds). Patients with a creatinine > 1.2 mg/dl or a history of
renal dysfunction must have glomerular filtration rate (GFR) > 40 mL/min/1.73m2.

- Adequate performance status is defined as Karnofsky score ≥ 60% (> 16 years of
age) or Lansky score ≥ 50 (pediatrics)

- If recent mold infection e.g. Aspergillus - must have minimum of 30 days of
appropriate treatment before BMT and infection controlled and be cleared by Infectious
Disease.

- Second BMT: Must be > 3 months after prior myeloablative transplant.

- Patients must be ineligible for autologous transplantation due to prior autologous
transplant, an inadequate autologous stem cell harvest, inability to withstand a
myeloablative preparative regimen, or clinically aggressive/high risk disease.

- Patients are eligible for transplantation if there is no evidence of progressive
disease by imaging modalities or biopsy. Persistent PET activity, though possibly
related to lymphoma, is not an exclusion criterion in the absence of CT changes
indicating progression.

- Patients with stable disease are eligible for transplantation if the largest residual
nodal mass is < 5 cm (approximately). For patients who have responded to preceding
therapy, the largest residual mass must represent a 50% reduction and be < 7.5 cm
(approximately).

- Voluntary written consent (adult or parental/guardian)

Exclusion Criteria:

- Available and clinically suitable 5-6/6 HLA-A, B, DRB1 matched sibling donor

- Pregnant or breastfeeding

- Evidence of HIV infection or known HIV positive serology

- Current active serious infection

- Unless in post-chemotherapy and radioimmunoconjugated antibody induced aplasia, when
he/she would be eligible, patients with acute leukemia in morphologic relapse/
persistent disease defined as > 5% blasts in normocellular bone marrow OR any % blasts
if blasts have unique morphologic markers (e.g. Auer rods) or associated cytogenetic
markers that allows morphologic relapse to be distinguished are not eligible.

- CML in refractory blast crisis

- Large cell lymphoma, mantle cell lymphoma and Hodgkin disease that is progressive on
salvage therapy. Stable disease is acceptable to move forward provided it is
non-bulky.

- active central nervous system malignancy